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More time in cram school ups risk of myopia in children

Jairia Dela Cruz
24 Jul 2018

Children spending longer hours in cram school are at greater risk of myopia, with the effect attributed to increased time doing near visual activity or reduced time spent outdoors, a Taiwan study has found.

“This study demonstrates that close visual work, especially cram school attendance 2 hours/day, is positively associated with higher risks of developing myopia in children,” the investigators said.

“It is possible that prolonged time spent in near visual work for homework, assignments and examinations at cram school may bring heavy pressure and hinder outdoor physical play, which has been recognized as an underlying factor of myopia,” they added.

The nationwide population-based study included 1,958 children aged 7–12 years, among whom 26.8 percent had myopia at baseline, while 27.7 percent of those who were not nearsighted at baseline developed myopia during 4 years of follow-up. [Ophthalmology 2018;doi:10.1016/j.ophtha.2018.05.010]

Among the three types of near visual activities in sedentary posture examined—cram school attendance, reading, and use of computer, internet and games—cram school attendance for ≥2 hours/day was associated with a heightened risk of developing myopia (hazard ratio, 1.31; 95 percent CI, 1.03–1.68). The results were robust to sensitivity analyses.

Of note, the children spent much higher time on average in cram school than for reading or using the computer/internet (2.78 vs 0.63 and 0.68 hours/day, respectively). This difference partially explains why the association for cram school attendance was stronger than for other types of near visual activities.

One important factor that may account for greater time spent in cram schooling is the need to achieve academic success, the investigators pointed out.

“Like many newly industrialized countries in Asia, most families in Taiwan are nuclear with few children. Given busy work schedules, most dual-earner parents are not able to pick up children from school on time. Moreover, although parents sometimes do not provide help with children’s homework after work, they expect their children to be academically successful,” they said.

“Therefore, enhancement of academic performance, especially in mathematics, science and English courses, could potentially be another key reason why cram schools are prevalent in Taiwan and other Asian countries,” they added.

It should be noted that time spent in cram school increases with age among elementary school children. The longer the time spent in cram school, the greater the amount of near visual activity. This, in turn, deprives children of time outdoors.

“It may be important for cram schools to decrease the time spent in near visual activities and increase outdoor activities to help prevent incident myopia,” the investigators said.

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