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  • Strabismus and Mental Health in Children

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, April 2022

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    Lee et al. assessed the association between strabismus and mental illness in the pediatric population. They found that children with strabismus had high­er odds of having anxiety, depression, bipolar disease, and schizophrenia than did those without eye diseases. Howev­er, the researchers did not find a similar association for substance use disorder.

    For this cross-sectional study, the researchers used claims data from the OptumLabs Data Warehouse for more than 12 million children younger than 19 years (mean age at time of first claim, 8 years) between Jan. 1, 2007, and Dec. 31, 2017. The main outcome measure was the presence of claims for five types of mental health problems.

    All told, 352,636 children had stra­bismus, while the remaining 11,652,553 had no eye disease diagnoses and served as the control group. Those with strabismus were slightly more likely to be female (50.1%, vs. 49.2% of con­trols) and White (51.6%, vs. 49.4% of controls).

    The adjusted odds ratios (ORs) for the association of mental illnesses with strabismus were as follows: 2.01 (95% confidence interval [CI], 1.99-2.04) for anxiety disorder, 1.83 (95% CI, 1.76-1.90) for schizophrenia, 1.64 (95% CI, 1.59-1.70) for bipolar disorder, 1.61 (95% CI, 1.59-1.63) for depressive disorder, and .99 (95% CI, .97-1.02) for substance use disorder. When analyzed by type of strabismus, ORs ranged from 1.23 (95% CI, 1.17-1.29) for the asso­ciation between esotropia and bipolar disorder to 2.70 (95% CI, 2.66-2.74) for the association between exotropia and anxiety disorder.

    In their discussion, the authors acknowledged that children with strabismus may be subject to negative social bias, which may raise their risk of developing mental health issues. They noted that additional studies on this topic are needed; for instance, they said, “it would be useful to study whether correction of strabismus can help men­tal illness.” They also recommended that ophthalmologists take two steps: 1) consider incorporating a mental health screening tool into their exam­inations of patients with strabismus, and 2) refer children with strabismus for a mental health evaluation. (Also see related commentary by S. Grace Praka­lapakorn, MD, MPH, Manpreet Kaur Singh, MD, MS, and Nathan Congdon, MD, MPH, in the same issue.)

    The original article can be found here.