Impact of vision impairment and ocular morbidity and their treatment on depression and anxiety in children: a systematic review

Dongfeng Li, Ving Fai Chan, Gianni Virgili, Prabhath Piyasena, Habtamu Negash, Noelle Whitestone, Sara O'Connor, Baixiang Xiao, Mike Clarke, David H. Cherwek, Manpreet K. Singh, Xinshu She, Huan Wang, Matthew Boswell, S. Grace Prakalapakorn, Jennifer L. Patnaik, Nathan Congdon*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)
525 Downloads (Pure)

Abstract

Topic
This systematic review and meta-analysis summarizes existing evidence to establish whether vision impairment, ocular morbidity, and their treatment are associated with depression and anxiety in children.

Clinical Relevance
Understanding and quantifying these associations support early detection and management of mental health symptoms in children with vision impairment and ocular morbidity. Additionally, this review provides evidence in favor of insurance coverage for timely strabismus surgery.

Methods
We searched 9 electronic databases from inception through February 18, 2021, including observational and interventional studies assessing whether vision impairment, ocular morbidity, or both and their treatment are associated with depression, anxiety, or both in children. We used narrative synthesis and meta-analysis with the residual maximum likelihood method. A protocol was registered and published on The International Prospective Register of Systematic Reviews (identifier: CRD42021233323).

Results
Among 28 992 studies, 28 956 studies (99.9%) were excluded as duplicates or unrelated content. Among 36 remaining studies, 21 studies (58.3%) were observational studies concerning vision impairment, 8 studies (22.2%) were observational studies concerning strabismus, and 7 studies (19.4%) were interventional studies. Vision impaired children demonstrated significantly higher scores of depression (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 normally sighted children. In particular, children with myopia demonstrated higher scores of depression (SMD, 0.58; 95% CI, 0.36–0.81; 6 studies) than normally sighted children. Strabismus surgery significantly improved symptoms of depression (SMD, 0.59; 95% CI, 0.12–1.06; 3 studies) and anxiety (SMD, 0.69; 95% CI, 0.25–1.14; 4 studies) in children.

Conclusion
Among children, vision impairment is associated with greater symptoms of depression and anxiety. Surgical treatment of strabismus improved these symptoms. Further randomized controlled trials exploring the impact of public health measures for myopia correction on mental health in children are needed. Scaling up access to strabismus surgery could improve the mental health of affected children.
Original languageEnglish
Pages (from-to)1152-1170
Number of pages19
JournalOphthalmology
Volume129
Issue number10
Early online date20 Sept 2022
DOIs
Publication statusPublished - Oct 2022

Keywords

  • depression
  • Vision impairment
  • anxiety
  • mental health
  • treatment
  • children
  • ocular morbidity

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