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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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This review summarizes existing evidence of the impact of vision impairment and ocular morbidity and their treatment on children’s quality of life (QoL).

Clinical Relevance
Myopia and strabismus are associated with reduced QoL among children. Surgical treatment of strabismus significantly improves affected children’s QoL.

We conducted a systematic review and meta-analysis by screening articles in any language in 9 databases published from inception through August 22, 2022, addressing the impact of vision impairment, ocular morbidity, and their treatment on QoL in children. We reported pooled standardized mean differences (SMDs) using random-effects meta-analysis models. Quality appraisal was performed using Joanna Briggs Institute and National Institutes of Health tools. This study was registered with the International Prospective Register of Systematic Reviews (identifier, CRD42021233323).

Our search identified 29 118 articles, 44 studies (0.15%) of which were included for analysis that included 32 318 participants from 14 countries between 2005 and 2022. Seventeen observational and 4 interventional studies concerned vision impairment, whereas 10 observational and 13 interventional studies described strabismus and other ocular morbidities. Twenty-one studies were included in the meta-analysis. The QoL scores did not differ between children with and without vision impairment (SMD, –1.04; 95% confidence interval [CI], –2.11 to 0.03; P = 0.06; 9 studies). Myopic children demonstrated significantly lower QoL scores than those with normal vision (SMD, –0.60; 95% CI, –1.09 to –0.11; P = 0.02; 7 studies). Children with strabismus showed a significantly lower QoL score compared with those without (SMD, –1.19; 95% CI, –1.66 to –0.73; P < 0.001; 7 studies). Strabismus surgery significantly improved QoL in children (SMD, 1.36; 95% CI, 0.48–2.23; P < 0.001; 7 studies). No randomized controlled trials (RCTs) concerning refractive error and QoL were identified. Among all included studies, 35 (79.5%) were scored as low to moderate quality; the remaining met all quality appraisal tools criteria.

Reduced QoL was identified in children with myopia and strabismus. Surgical correction of strabismus improves the QoL of affected children, which supports insurance coverage of strabismus surgery. Further studies, especially RCTs, investigating the impact of correction of myopia on QoL are needed.

Original languageEnglish
Pages (from-to)188-207
Number of pages20
Issue number2
Early online date09 Sept 2023
Publication statusPublished - Feb 2024


  • Systematic review
  • Childhood vision impairment
  • Quality of life
  • Strabismus
  • Myopia


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