Vision impairment tied to symptoms of depression, anxiety in children

Children with vision impairment are at higher risk of developing symptoms of depression and anxiety, according to a study, noting that surgical treatment of strabismus may improve these symptoms.

“Scaling up access to strabismus surgery could improve the mental health of affected children,” said the researchers, led by Dongfeng Li, Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Li and colleagues searched nine electronic databases from inception through 18 February 2021 for observational and interventional studies that assessed whether vision impairment, ocular morbidity, or both and their treatment correlated with depression, anxiety, or both in children. Narrative synthesis and meta-analysis were used with residual maximum likelihood method.

A total of 28,992 studies were identified, of which 28,956 (99.9 percent) were excluded due to duplication or unrelated content. Of the 36 remaining studies, 21 (58.3 percent) were observational focusing on vision impairment, eight (22.2 percent) were observational concerning strabismus, and seven (19.4 percent) were interventional. [Ophthalmology 2022;129:1152-1170]

Children with vision impairment showed evidently higher scores of depression (standard mean difference [SMD], 0.57, 95 percent confidence interval [CI], 0.26‒0.89; 11 studies) and anxiety (SMD, 0.62, 95 percent CI, 0.40‒0.83; 14 studies) than those with normal eyesight.

Myopic children, in particular, had higher scores of depression (SMD, 0.58, 95 percent CI, 0.36‒0.81; six studies) than their normally sighted counterparts.

Of note, strabismus surgery led to significant improvements in symptoms of both depression (SMD, 0.59, 95 percent CI, 0.12‒1.06; three studies) and anxiety (SMD, 0.69, 95 percent CI, 0.25‒1.14; four studies) in children.

“Interventional studies showed that treating strabismus could improve mental health, including depression and anxiety,” the researchers said.

“The worldwide estimated prevalence of strabismus is as high as 1.93 percent, and the present review indicates that early detection and treatment may impact children’s mental health profoundly,” they added. [Strabismus 2019;27:54-65]

Developing countries

As early as 6 years of age, negative attitudes toward strabismus may already arise, and this only increases with age, according to another study. [Br J Ophthalmol 2011;95:473-476]

In developing countries, including China, India, and Vietnam, strabismus surgery is usually considered cosmetic and may not be covered by medical insurance. [Kerala J Ophthalmol 2017;29:102; Ophthalmology 2017;25:38-40; Int J Healthc Manag 2021;14:1382-1388]

The average cost of strabismus surgery is $700.67 in China and $152.68 in Vietnam. Eight in 10 patients in China used their own money for surgery, which could be a deterrent for those of low socioeconomic status.

“Understanding and quantifying these associations support early detection and management of mental health symptoms in children with vision impairment and ocular morbidity,” the researchers said.

“This review also underscored the importance and potential impact of early detection and treatment of strabismus in children and provides evidence in favour of insurance coverage for timely strabismus surgery to help improve children’s overall health and, in turn, decrease costs for future mental health disorders,” they added.