Evaluation of myopia progression in different educational models

BACKGROUND: Myopia is a leading cause of distance vision impairment and a growing global public health concern. This study investigates the association between different educational models, defined as the type of schooling system and its associated curricular and environmental characteristics, and myopia progression in school-aged children. METHODS: This retrospective observational study included 342 myopic students aged 10–15 years in Uşak, Türkiye, divided into three groups: Group 1 (standard curriculum), Group 2 (rote-learning boarding school), and Group 3 (project-based education for gifted students). All underwent at least two examinations, including cycloplegic autorefraction and optical biometry. Annual changes in spherical equivalent (ΔSE) and axial length (ΔAL) were analyzed using multivariable linear regression adjusted for age, sex, parental myopia, screen time, and follow-up duration, with generalized estimating equation (GEE) models as sensitivity analyses. RESULTS: Group 2 demonstrated the highest annual myopic progression (− 0.37 ± 0.16 D/year), followed by Group 1 (− 0.23 ± 0.22 D/year) and Group 3 (− 0.21 ± 0.15 D/year; p < 0.001). After adjustment, Group 2 showed significantly faster progression than Group 1 (β = −0.161 D/year; 95% CI: −0.219 to − 0.103; p < 0.001), while Group 3 had significantly less axial elongation (β = −0.026 mm/year; 95% CI: −0.044 to − 0.009; p = 0.003). GEE sensitivity analysis confirmed these results. CONCLUSIONS: The educational environment is independently associated with myopia progression in children. Intensive near-work educational settings were associated with faster myopic shift. The educational context should be considered when developing myopia prevention strategies.