Vision Impairment Associated With Pediatric Depression and Anxiety, Review Finds

A systematic review found that vision impairment was associated with greater symptoms of depression and anxiety in children.

A systematic review published in Ophthalmology found that children with vision impairment displayed greater symptoms of anxiety and depression than children with normal eyesight.

The researchers used the MEDLINE, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews, the Cochrane Register of Controlled Trials in the Cochrane Library, CINAHL, and Chinese databases WANFANG MED ONLINE and China National Knowledge Infrastructure to search for studies from inception to February 18, 2021.

Studies that had enrolled children or young adults, were observational and interventional, that included a comparison group, with outcome variables that included prevalence and/or scores for depression and/or anxiety, and that were published in peer-reviewed journals were eligible for inclusion. Thirty-six studies were included in the systematic review.

The 21 observational studies concerned with vision impairment had 7064 participants with a mean (SD) sample size of 346 (363). Depression and anxiety were published in 16 and 17 studies, respectively. The 8 observational studies concerned with strabismus had 668,463 participants; depression and anxiety were reported in 6 and 8 of the studies, respectively. The 7 studies concerning an intervention had 20,930 participants.

Children with vision impairment had higher depression scores than controls (standard mean difference [SMD], 0.57; 95% CI, 0.26-0.89) in the 11 studies that reported scores for depression. Significantly higher depression scores were recorded in the 6 studies where myopia was the cause of vision impairment (SMD, 0.59; 95% CI, 0.36-0.81) vs children with normal vision. There were 5 studies with other causes of vision impairment that demonstrated a similar point estimate (SMD, 0.58; 95% CI, ­–0.08 to 1.25).

Visually impaired children had higher anxiety scores (SMD, 0.61; 95% CI, 0.40-0.82) in the 14 studies that recorded this outcome. Scores did not differ between groups of children with myopic vision impairment (SMD, 0.48; 95% CI, 0.32-0.64) compared with other causes of vision impairment (SMD, 0.93; 95% CI, 0.34-1.53).

Strabismus surgery was also found to significantly improve the symptoms of depression (SMD, 0.59; 95% CI, 0.12-1.06) and anxiety (SMD, 0.69; 95% CI, 0.25-1.14).

There were some limitations to this review. There was high heterogeneity in the included studies, all observational studies that concerned vision impairment were cross-sectional, and the interventional studies followed before-after designs without a control group. In addition, there was also only 1 randomized control trial for myopia, and the average age of the participants in the studies concerning vision impairment and strabismus were 14.9 and 9.78 years, respectively, which may make it hard to generalize the results for children of all ages.

The researchers concluded that their findings were important for health care planners that design interventions and prioritize resource allocation. They also wrote that their findings encourage early detection and treatment of strabismus.


Li D, Chan VF, Virgili G, et al. Impact of vision impairment and ocular morbidity and their treatment on depression and anxiety in children: a systematic review. Ophthalmology. Published online May 31, 2022. doi:10.1016/j.ophtha.2022.05.020