“…Participants with manual occupations and those living in rural areas were also more likely to be myopic and have astigmatism. Some of these findings contrast with other populationbased studies, which have shown associations between myopia, higher education levels, professional occupations and residence in urban areas 25,26,32,33,40,43,46,48,51 (in support of the use-abuse theory of myopia). There are, however, exceptions to these trends: The Baltimore Eye Study showed that the association between years of education and myopia was stronger for white persons than for black persons, 35 the Chennai Study (India) showed a higher prevalence of myopia in participants living in rural areas, 49 and the Bangladesh study showed a significantly lower risk of myopia with literacy, urban living, and nonmanual occupation.…”