Vision Impairment Increases Depression, Anxiety in Children

Backlit child sitting in a dark doorway in contemplation
Researchers assess depression and anxiety in children with visual impairment and investigate the role of strabismus surgery in improving mental health.

Vision impairment is associated with elevated symptoms of depression and anxiety among children, but strabismus surgery can improve these symptoms, according to research published in Ophthalmology

Researchers searched 9 electronic databases for studies evaluating whether vision impairment or ocular morbidity and their respective treatments are related to depression and anxiety in children. Among the 36 studies included in the systematic review, 21 (58.3%) were observational studies investigating vision impairment, 8 (22.2%) were observational studies assessing strabismus, and 7 (19.4%) were interventional studies. 

According to the report, children with vision impairment had significantly higher depression (standard mean difference [SMD], 0.57; 95% CI, 0.26-0.89; 11 studies) and anxiety scores (SMD, 0.61; 95% CI, 0.40-0.821; 14 studies) compared with children with normal vision. In particular, children with myopia had higher depression scores (SMD, 0.59; 95% CI, 0.36-0.81; 6 studies) than children with normal vision. Surgically treating children with strabismus significantly improved symptoms of depression (SMD, 0.59; 95% CI, 0.12-1.06; 3 studies) and anxiety (SMD, 0.69; 95% CI, 0.24-1.14; 4 studies).  

“While the prevalence of ocular morbidity, depression, and anxiety are lower among children compared to adults, the total burden of these conditions is higher due to the length of time children are affected if the underlying disorders are not identified and corrected,” according to the researchers. “Furthermore, adolescents experiencing sub-threshold depressive symptoms have an increased risk of developing mental health problems, such as depression, anxiety, substance dependence, and suicide later in life.”

Study limitations include the high heterogeneity among the studies included, only 1 randomized controlled trial (RCT) for myopia, and the overall quality of most studies included was low to moderate.

Disclosure: This research was supported by Santen Pharmaceutical Co. and Orbis International. Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


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. Ophthalmol. Published online May 31, 2022. doi:10.1016/j.ophtha.2022.05.020