Vision impairment linked with symptoms of depression, anxiety in children
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Children with vision impairment were more likely to experience symptoms of depression and anxiety, which significantly improved after strabismus surgery, according to a systematic review and meta-analysis in Ophthalmology.
“Although the prevalence of ocular morbidity, depression and anxiety are lower among children than among adults, the total burden of these conditions is higher because of the length of time children are affected if the underlying disorders are not identified and corrected,” Dongfeng Li, MMed, of the department of ophthalmology at Sichuan Provincial People’s Hospital at the University of Electronic Science and Technology of China, and colleagues wrote.
Researchers searched nine electronic databases for observational and interventional studies to determine whether vision impairment, ocular morbidity and subsequent treatment affect the mental health of children younger than 18 years old. Databases included were Medline, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials in the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Wanfang Med Online and China National Knowledge Infrastructure.
Of 28,992 studies identified, more than 99% were duplicates or contained unrelated content, leaving 36 for inclusion in the review. Of those, 21 (58.3%) were observational studies on vision impairment, eight (22.2%) were observational studies on strabismus, and seven (19.4%) were interventional studies.
Eleven studies included scores for depression, in which children with a vision impairment recorded higher scores of depression compared with normal-sighted children (standard mean difference [SMD] = 0.57; 95% CI, 0.26-0.89). Higher scores of depression also were found in children in six studies in which myopia was the vision impairment (SMD = 0.58; 95% CI, 0.36-0.81). In addition, visually impaired children showed significantly higher scores of anxiety (SMD = 0.62; 95% CI, 0.4-0.83) in 14 studies.
Results also revealed that strabismus surgery significantly improved symptoms of depression in children in three studies (SMD = 0.59; 95% CI, 0.12-1.06) and anxiety in four studies (SMD = 0.69; 95% CI, 0.25-1.14).
Li and colleagues acknowledged that the results of their review and analysis may not be widely applicable, as 22 studies were from low- and middle-income countries and nine that focused on myopia were conducted in China.
“We suggest that further [randomized, controlled trials] on myopia correction and its impact on mental health are needed to identify strategies to improve the mental health of children with myopia,” Li and colleagues wrote. “This review also underscored the importance and potential impact of early detection and treatment of strabismus in children and provides evidence in favor of insurance coverage for timely strabismus surgery to help improve children’s overall health and, in turn, decrease costs for future mental health disorders.”
Perspective
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It is not surprising to see that vision impairment in children has been linked to higher rates of mental health issues, such as depression and anxiety. This systemic review has found that untreated strabismus and uncorrected refractive errors are major ophthalmic conditions that exacerbate depression and anxiety in children. This is a strong indication that early detection of these conditions is crucial for a child’s success in school and social settings. Promoting yearly eye exams in school-aged children should be a national health concern. In addition, strabismus needs to be addressed as more than a cosmetic concern in young children. We need to take the time consider their functional vision needs and educate parents accordingly. This study suggests that treatment, such as strabismus surgery, can make a definitive impact on improving depression symptoms.
As busy practitioners, it is easy to forget the significant impact a diagnosis and treatment plan can have on a child’s development, education and mental health. It is imperative that we take the time to educate families and make appropriate referrals for mental health care when indicated. More research in this area, particularly randomized, controlled trials, is needed to truly define the correlations between vision impairments and mental health issues.
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Li D, et al. Ophthalmology. 2022;doi:10.1016/j.ophtha.2022.05.020.
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