Cataracts Associated With Developmental Delay, Anxiety in Children

Ophthalmologist doing an eye test on a boy
Ophthalmologist doing an eye test on boy in a light bright, stylish modern clinic, using a autorefractor
The risk was especially elevated in those who developed cataracts in the first 3 years of life, according to a report.

The risk of mental disorders is markedly increased in children with cataracts, especially in those diagnosed in the first 3 years of life, according to findings published in the American Journal of Ophthalmology. 

Researchers conducted a nationwide cohort study to examine the incidence of mental disorders in children with cataracts compared with children without cataracts. The incidence of mental disorders in children born between 2000 and 2017 who were diagnosed with cataract before age 10 years of age (n=485) from entries in comprehensive national databases were included. The sample was then compared with sex- and age-matched controls (n=4358). Somatic disease, parent socioeconomic status, and psychiatric morbidity were adjusted for in analysis.

The study found that, compared with controls, the incidence of mental disorders was nearly doubled in children with cataract (OR=1.83, 95% CI=1.28-3.63), with the risk of anxiety disorders quadrupled (OR=4.10, 95% CI=1.90-8.84), and the risk of developmental delay doubled (OR=2.66; 95% CI=1.45-4.90). In the first 3 years of life, the risk of mental disorders was significantly higher in children diagnosed with cataract compared with participants in the control group (OR=2.36; 95% CI=1.53-3.64).The risk of mental disorders was highest in children who had cataract in combination with a systemic disease, according to the study.

The researchers explain that, while the increased risk of neurodevelopmental disorders in children with cataract was unsurprising, the quadrupled risk of anxiety disorders was remarkable. However, they note that this finding aligned with previous findings on other chronic diseases, such as epilepsy and type I diabetes.

“Children with cataract are exposed to repeated examinations under anesthesia and hospital appointments, at-home patching therapy for amblyopia, and they may suffer from visual impairment associated with cataract, which influences social interactions, e.g. response to facial expressions,” the study explains.

On this topic, the study also notes that it is possible its findings regarding anxiety are underestimated due to the fact that the disorder often presents in adolescent youth — a population it did not include.

The researchers note study strengths such as its nationwide scope without attrition bias, and adjustment for certain variables to avoid confounding. Study limitations include possible selection bias and referral bias due to the interdisciplinary nature of hospital environments. 


Al-Bakri M , Skovgaard AM, Bach-Holm D, Larsen DA , Siersma V, Kessel L. Increased incidence of mental disorders in children with cataract–findings from a population-based study. Am J Ophthalmol. Published online October 11, 2021. doi:10.1016/j.ajo.2021.09.034