Visual impairment linked to symptoms of depression, anxiety in children | Latest news for doctors, nurses and pharmacists

Children with low vision are at higher risk of developing symptoms of depression and anxiety, a study has found, noting that surgical treatment for strabismus can improve these symptoms.

“Expanding 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 the start to Feb. 18, 2021, for observational and interventional studies that assessed whether visual impairment, ocular morbidity, or both and their treatment correlated with depression, anxiety, or both in children. Narrative synthesis and meta-analysis were used with the residual maximum likelihood method.

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

Visually impaired children had significantly higher depression scores (standard mean difference [SMD]0.57, 95% confidence interval [CI], 0.26‒0.89; 11 studies) and anxiety (SMD, 0.62, 95% CI, 0.40‒0.83; 14 studies) than those with normal vision.

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

Of note, strabismus surgery resulted in significant improvements in symptoms of depression (SMD, 0.59, 95% CI, 0.12‒1.06; three studies) and anxiety (SMD, 0. 69, 95% CI, 0.25‒1.14; four studies) in children.

“Interventional studies have shown that treating strabismus can improve mental health, including depression and anxiety,” the researchers said.

“The estimated global prevalence of strabismus is as high as 1.93%, and this study indicates that early detection and treatment can have a profound impact on children’s mental health,” they added. [Strabismus 2019;27:54-65]

Developing countries

From the age of 6, negative attitudes towards strabismus can 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 generally 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 out of 10 patients in China used their own money for the surgery, which could be a deterrent for people of low socioeconomic status.

“Understanding and quantifying these associations supports early detection and management of mental health symptoms in children with visual 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 favor of insurance coverage for timely strabismus surgery to help improve the overall health of children and, in turn, reduce the costs of future mental health disorders,” they added.

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