Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China; Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
Ophthalmology. 2022 Oct;129(10):1152-1170. doi: 10.1016/j.ophtha.2022.05.020. Epub 2022 May 31.
This systematic review and meta-analysis summarizes existing evidence to establish whether vision impairment, ocular morbidity, and their treatment are associated with depression and anxiety in children.
Understanding and quantifying these associations support early detection and management of mental health symptoms in children with vision impairment and ocular morbidity. Additionally, this review provides evidence in favor of insurance coverage for timely strabismus surgery.
We searched 9 electronic databases from inception through February 18, 2021, including observational and interventional studies assessing whether vision impairment, ocular morbidity, or both and their treatment are associated with depression, anxiety, or both in children. We used narrative synthesis and meta-analysis with the residual maximum likelihood method. A protocol was registered and published on The International Prospective Register of Systematic Reviews (identifier: CRD42021233323).
Among 28 992 studies, 28 956 studies (99.9%) were excluded as duplicates or unrelated content. Among 36 remaining studies, 21 studies (58.3%) were observational studies concerning vision impairment, 8 studies (22.2%) were observational studies concerning strabismus, and 7 studies (19.4%) were interventional studies. Vision impaired children demonstrated significantly higher scores of depression (standard mean difference [SMD], 0.57; 95% confidence interval [CI], 0.26-0.89; 11 studies) and anxiety (SMD, 0.62; 95% CI, 0.40-0.83; 14 studies) than normally sighted children. In particular, children with myopia demonstrated higher scores of depression (SMD, 0.58; 95% CI, 0.36-0.81; 6 studies) than normally sighted children. Strabismus surgery significantly improved symptoms of depression (SMD, 0.59; 95% CI, 0.12-1.06; 3 studies) and anxiety (SMD, 0.69; 95% CI, 0.25-1.14; 4 studies) in children.
Among children, vision impairment is associated with greater symptoms of depression and anxiety. Surgical treatment of strabismus improved these symptoms. Further randomized controlled trials exploring the impact of public health measures for myopia correction on mental health in children are needed. Scaling up access to strabismus surgery could improve the mental health of affected children.
本系统评价和荟萃分析总结了现有证据，以确定视力障碍、眼部发病率及其治疗与儿童抑郁和焦虑之间是否存在关联。
了解和量化这些关联有助于早期发现和管理视力障碍和眼部发病率儿童的心理健康症状。此外，本综述提供了支持及时进行斜视手术以获得保险覆盖的证据。
我们从建库开始至 2021 年 2 月 18 日检索了 9 个电子数据库，包括评估视力障碍、眼部发病率或两者及其治疗与儿童抑郁、焦虑或两者之间是否存在关联的观察性和干预性研究。我们使用叙述性综合法和剩余最大似然法进行荟萃分析。方案已在国际前瞻性系统评价登记处（登记号：CRD42021233323）进行了注册和发表。
在 28992 项研究中，28956 项研究（99.9%）因重复或内容不相关而被排除。在 36 项剩余研究中，21 项研究（58.3%）为视力障碍的观察性研究，8 项研究（22.2%）为斜视的观察性研究，7 项研究（19.4%）为干预性研究。与视力正常的儿童相比，视力受损的儿童表现出明显更高的抑郁评分（标准化均数差 [SMD]，0.57；95%置信区间 [CI]，0.26-0.89；11 项研究）和焦虑评分（SMD，0.62；95%CI，0.40-0.83；14 项研究）。特别是，近视儿童的抑郁评分（SMD，0.58；95%CI，0.36-0.81；6 项研究）明显高于视力正常的儿童。斜视手术显著改善了儿童的抑郁症状（SMD，0.59；95%CI，0.12-1.06；3 项研究）和焦虑症状（SMD，0.69；95%CI，0.25-1.14；4 项研究）。
在儿童中，视力障碍与更严重的抑郁和焦虑症状相关。斜视手术治疗可改善这些症状。需要进一步的随机对照试验来探索针对儿童近视的公共卫生措施对心理健康的影响。扩大斜视手术的可及性可以改善受影响儿童的心理健康。
