Effect of a non-pressure education system on myopia in Japan

Reviewed by Satoshi Ishiko, MD

Studying the prevalence of myopia in children during the COVID‐19 pandemic is important, and conducting a follow-up study on the same population as they grow older would also be instructive.

The study of myopia in adults exposed to different educational environments would also shed light on the development of myopia.

Myopia is a global epidemic that is due in part to educational pressures, particularly in Asian populations.

According to Satoshi Ishiko, MD, of the Department of Combined Research Institute of Medicine and Engineering, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.

The education system in Japan has always been intense for students and is characterized by cramming, rote learning, drill and testing, resulting in a high-pressure educational environment often leading to, for example, dropping out of school. , bullying and absenteeism.

In recognition of this, a less intense school curriculum was launched nationally in 2002 for the first 9 years of compulsory education based on a relaxed educational environment. Japan also moved to a 5-day school week and eliminated Saturday classes.

The “Yutori” education policy, which began in fiscal 2012, reduced class hours and learning content.

Study of the effect of less academic pressure
Ishiko and colleagues undertook a retrospective observational study to determine the effect of educational pressure on myopia before and after the introduction of the Yutori educational system.1

A total of 1025 Japanese medical students at Asahikawa Medical University underwent spherical equivalent (SE) and axial length (AL) measurements from April 2011 to February 2020. The students’ birth years ranged from 1961 to 1997.

The initiation of the Yutori pedagogical approach in 2002 corresponded to the year of birth of the student 1987.

The new system has gradually reduced the number of class hours and learning content over the past 10 years until 2012.

Ultimately, data from 995 students were analyzed, after excluding students who had undergone LASIK or wore orthokeratology lenses or were born in a year with too few students to analyze.

Investigators found that SE and AL were significantly correlated with years of birth (p = 0.004 and p = 0.034, respectively) only during the duration of the high-pressure education system.

The regression rates of SE and AL during the two educational approaches differed significantly (p = 0.004 and p = 0.037, respectively). The prevalence of high myopia was significant (p

The regression of high myopia prevalence rates during the two educational approaches differed significantly (p = 0.010).

Commenting on the correlation between SE and AL, the investigators reported: “During high-pressure education, SE decreased by approximately 0.16 D per year and AL increased by approximately 0. 05 mm per year, which corresponds to about 3.0 D/mm. Therefore, the refractive change to myopia was accompanied by an AL elongation,” they said.

This was similar to previously reported results.2.3

In this comparative study of the degree and prevalence of myopia before and after the introduction of free-pressure education in Japan, the results indicated that the compulsory education curriculum policy appeared to be associated with the progression of myopia.

During the period of compulsory education, Ishiko commented, children do not have a choice of their educational environment, as the school curriculum is determined by the government.

Since the educational environment can influence the progression of myopia, the government should appoint an ophthalmologist to the evaluation committee of the education system.

To control the progression of myopia, it is important to inform parents and educators of the harmful effects of prolonged hours of close work and the beneficial effects of outdoor activities.

Myopia control requires teamwork.

“In order to control the progression of myopia, not only ophthalmologists but also educators and the government should work together,” Ishiko concluded.

Satoshi Ishiko, MD
Email: ishiko@asahikawa-med.ac.jp
The authors had no conflict of interest related to this topic.


1. Ishiko S, Kagokawa H, Nishikawa N, et al. Impact of non-pressure Yutori education program on myopia in Japan. J Clin Med 2021;10:4229; https://doi.org/10.3390/jcm10184229

2. Kinge B, Midelfart A, Jacobsen G, Rystad J. Biometric changes in the eyes of Norwegian university students – A three-year longitudinal study. Acta Ophthalmol Scand 1999;77:648–52, doi:10.1034/j.1600‐0420.1999.770608.x.

3. Lin LL-K, Shih Y-F, Lee Y-C, et al. Changes in ocular refraction and its components in medical students??? A 5-year longitudinal study. Optom Vis Sci 1996;73:495–8, doi:10.1097/00006324‐199607000‐00007.

Janice G. Ball