Los Angeles: A recent study in JAMA Ophthalmology has suggested a moderate association between strabismus and mental illness including schizophrenia, anxiety disorder, depressive disorder, and bipolar disorder but not substance use disorder.
"Considering the existence of these associations, mental illness screening and treatment should be encouraged in children with strabismus," Yoon H. Lee, University of California, Los Angeles, Los Angeles, and colleagues wrote in their study.
Children with strabismus have a poorer functional vision and decreased quality of life than their counterparts without strabismus. Dr. Lee and colleagues aimed to evaluate the association between strabismus and mental illness among children in a cross-sectional study.
The study analyzed claims data from the OptumLabs Data Warehouse, a longitudinal de-identified commercial insurance claims database, from 12 005 189 patients enrolled in the health plan between January 1, 2007, and December 31, 2017. Patients younger than 19 years at the time of strabismus diagnosis, enrollment in the health plan between 2007 and 2018, and having at least 1 strabismus claim based on International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes were eligible to participate. Children in the same database with no eye disease codes other than refractive error reported were controls. The researchers compared demographic characteristics and mental illness claims were compared.
Based on the study, the researchers reported the following findings:
Among the 12 005 189 patients (6 095 523 boys; mean age, 8.0 years) in the study, adjusted odds ratios for the association of mental illnesses with strabismus were 2.01 for anxiety disorder, 1.83 for schizophrenia, 1.64 for bipolar disorder, 1.61 for depressive disorder, and 0.99 for substance use disorder.
There was a moderate association between each strabismus type (esotropia, exotropia, and hypertropia) and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder; odds ratios ranged from 1.23 for the association between esotropia and bipolar disorder to 2.70 for the association between exotropia and anxiety disorder.
The authors conclude, "understanding the association of mental illness with strabismus in children may improve the diagnosis and management of psychiatric conditions for children with strabismus."
Reference:
Lee YH, Repka MX, Borlik MF, et al. Association of Strabismus With Mood Disorders, Schizophrenia, and Anxiety Disorders Among Children. JAMA Ophthalmol. Published online March 10, 2022. doi:10.1001/jamaophthalmol.2022.0137
KEYWORDS: mental illness, strabismus, eye disorder, mood disorders, schizophrenia, anxiety disorders, eye disease, Yoon H Lee, children, childhood, JAMA