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Participants underwent comprehensive ophthalmologic examinations as part of the 5-year follow-up examination in 2012\u20132017 including genotyping. The spherical equivalent and axial length distributions were modeled with gaussian mixture models. Regression analysis (on person-individual level) was performed to analyze associations between biometric parameters and educational factors. Mendelian randomization analysis explored the causal effect between spherical equivalent, axial length, and education. Additionally, effect mediation analysis examined the link between spherical equivalent and education.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 8532 study participants were included (median age: 57 years, 49% female). The distribution of spherical equivalent and axial length follows a bi-Gaussian function, partially explained by the length of education (i.e.,\u2009&lt;\u200911 years education vs. 11\u201320 years). Mendelian randomization indicated an effect of education on refractive error using a genetic risk score of education as an instrument variable (\u2212\u20090.35 diopters per SD increase in the instrument, 95% CI,\u2009\u2212\u20090.64\u20130.05, <jats:italic>p<\/jats:italic>\u2009=\u20090.02) and an effect of education on axial length (0.63\u00a0mm per SD increase in the instrument, 95% CI, 0.22\u20131.04, <jats:italic>p<\/jats:italic>\u2009=\u20090.003). Spherical equivalent, axial length and anterior chamber depth were associated with length of education in regression analyses. Mediation analysis revealed that the association between spherical equivalent and education is mainly driven (70%) by alteration in axial length.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The distribution of axial length and spherical equivalent is represented by subgroups of the population (bi-Gaussian). This distribution can be partially explained by length of education. The impact of education on spherical equivalent is mainly driven by alteration in axial length.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00417-024-06395-z","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T13:02:21Z","timestamp":1709730141000},"page":"1819-1828","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Bi-Gaussian analysis reveals distinct education-related alterations in spherical equivalent and axial length\u2014results from the Gutenberg Health Study"],"prefix":"10.1007","volume":"262","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8721-6036","authenticated-orcid":false,"given":"Alica","family":"Hartmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie Desir\u00e9e","family":"Grabitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix Mathias","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp Sebastian","family":"Wild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"M\u00fcller-Nurasyid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl Johannes","family":"Lackner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred Elmar","family":"Beutel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"T\u00fcscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rn Markus","family":"Schattenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Pfeiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Karl-Georg","family":"Schuster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"key":"6395_CR1","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1097\/opx.0000000000000296","volume":"91","author":"JJ Rozema","year":"2014","unstructured":"Rozema JJ, Tassignon MJ (2014) The bigaussian nature of ocular biometry. 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Written informed consent was obtained from all study participants prior to their study entry and the GHS complies with Good Clinical Practice (GCP), Good Epidemiological Practice (GEP). The study protocol and study documents were approved by the ethics committee of the Medical Chamber of Rhineland-Palatinate, Mainz, Germany (reference no. 837.020.07).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Schuster AK holds the professorship for ophthalmic healthcare research endowed by \u201cStiftung Auge\u201d and financed by \u201cDeutsche Ophthalmologische Gesellschaft\u201d and \u201cBerufsverband der Augen\u00e4rzte Deutschlands e.V.\u201d Schuster AK acted as consultant for Apellis and Abbvie, and\u00a0received financial and research support by Abbvie, Bayer Vital, Heidelberg Engineering, Novartis, Santen.Wild PS is funded by the Federal Ministry of Education and Research (BMBF 01EO1503) and he and M\u00fcnzel T are PI of the German Center for Cardiovascular Research (DZHK). Pfeiffer N receives financial support by Novartis, Ivantis, Santen, Thea, Boehringer Ingelheim Deutschland GmbH & Co. KG, Alcon, Sanoculis.Schattenberg JM acts as consultant to Apollo Endosurgery, Bayer, Boehringer Ingelheim, BMS, Gilead Sciences, GSK, Intercept Pharmaceuticals, Ipsen, Inventiva Pharma, Madrigal, MSD, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Siemens Healthineers. Research Funding: Gilead Sciences, Boehringer Ingelheim, Siemens Healthcare GmbH.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}