New study finds that myopia in children is linked to higher rates of depression and anxiety

A new study published on May 31 in the journal Ophthalmology has found that children with myopia (nearsightedness) experience significantly higher levels of depression and anxiety than their peers without vision impairment.

The study also found that surgery to correct strabismus (misalignment of the eyes) significantly improved symptoms of depression and anxiety in children.

Few studies on links between depression/anxiety and myopia in children

There was already a large body of work focused on the links between vision impairment and depression and anxiety in adults.  

A 2021 systematic review, for example, found that the prevalence of depression among patients with vision impairment aged older than 65 years was 25%, much higher than for the general population of older adults.

It has also been estimated that 16% of older adults with vision impairment face sub-threshold anxiety (that is, anxiety symptoms that are mild and/or brief but recurrent), with almost 8% being diagnosed with anxiety disorders.

But there are not many studies investigating these links in children, and the issue had not yet been reviewed in a comprehensive way until the present study.

Meta-analysis involving almost 700,000 children

The current study was a meta-analysis of 36 previous studies conducted between 1986 – 2020 in the United States, China, Turkey, South Korea, Iran, Israel, and elsewhere.

In total, the 36 studies that formed the meta-analysis included almost 700,000 participants.

The average age of the children in the studies that addressed vision impairment was 15.

The present study was conducted by 16 researchers from universities in the United States, China, Ireland, and beyond.

It found that vision-impaired children experienced significantly higher scores for depression (standard mean difference of 0.57) and anxiety (SMD of 0.61) than normally-sighted children.

The link was particularly strong for myopic children.

The results also varied somewhat in terms of anxiety and depression.

When it came to anxiety, the difference in scores between children with visual impairment due to either myopia or other causes were both significant.

The difference in depression scores, on the other hand, was only significant among children with myopia, but not in children with other forms of visual impairment.

Why might myopia in children lead to depression and/or anxiety?

The study suggests that the mental health of children with myopia or other forms of vision impairment may be adversely affected because such children tend to participate in fewer physical activities, have lower academic achievement, and are more socially isolated.

Likewise, common vision conditions such as strabismus can negatively impact children’s development and maturation because they affect not only the children’s appearance (which can in turn affect their confidence and feelings of social belonging), but also their ability to carry out certain activities.

A solvable problem

Uncorrected refractive error (a cateory that includes myopia, hyperopia, astigmatism, and presbyopia) continues to be the leading cause of vision impairment worldwide.

Indeed, many of the studies included in this meta-analysis were conducted in China, which likely reflects the high prevalence of myopia in children there.

Recent research has found that more than half of the children aged 6-18 years in China are myopic.

One of the current study’s co-authors, Nathan Congdon of Queen’s University Belfast, said he hopes that this new study “can help spur governments to action” to address the serious mental health consequences of strabismus and myopia in children.

These results are all the more compelling, he adds, because the strongest evidence that the study found in terms of vision problems having a negative impact on mental health was among kids with nearsightedness, which is easily treatable with a simple pair of glasses.

“Certainly, it is encouraging for program planners that the children whose vision impairment is most strongly linked with depression and anxiety, i.e. those with myopia, have the most readily treatable ocular condition,” the authors write.

Making vision treatments more accessible

More accessible eye care treatments will improve children’s mental health and overall well-being.

For example, in some countries (such as China, India, and Vietnam), strabismus surgery is seen as a cosmetic procedure and is thus excluded from insurance coverage, which forces families to pay out-of-pocket.

These barriers could discourage the families of lower-income patients from seeking treatment, thereby keeping the mental health benefits of this corrective surgery out of reach.

The estimated worldwide prevalence of strabismus is close to 2%, and the present review indicates that early detection and treatment of this condition might profoundly impact children’s mental health worldwide.

This research has important implications, the researchers say, for health care planners when allocating resources and designing interventions to curb vision impairment.

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Study: “Impact of vision impairment and ocular morbidity and their treatment on depression and anxiety in children: A systematic review”
Authors: Dongfeng Li, Ving Fai Chan, Gianni Virgili, Prabhath Piyasena, Habtamu Negash, Noelle Whitestone, et al.
Published: May 31, 2022
Published in: Ophthalmology
DOI: https://doi.org/10.1016/j.ophtha.2022.05.020

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