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Hinterhuber L, Rezar-Dreindl S, Schmidt-Erfurth U, Stifter E. Postoperative outcome and influencing factors of strabismus surgery in infants aged 1-6 years. Graefes Arch Clin Exp Ophthalmol 2024; 262:2299-2307. [PMID: 38363357 PMCID: PMC11222223 DOI: 10.1007/s00417-024-06404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/14/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To evaluate the postoperative outcome of strabismus surgery performed in children aged 1-6 years by investigating the change of the preoperative angle of deviation (AOD), elevation in adduction, best-corrected visual acuity (BCVA) and refractive error. METHODS Retrospective chart review of 62 children who received strabismus surgery between January 2018 and December 2021 at the Department of Ophthalmology and Optometry of the Medical University of Vienna. Age, sex, type of strabismus, AOD, BCVA, refractive error and visual acuity were evaluated with respect to the postoperative outcome. RESULTS Mean follow-up was 13.55 ± 11.38 months with a mean age of 3.94 ± 1.97 years (range: 1.0-6.0) at time of surgery. 74.19% of patients (n = 46) had isolated or combined esotropia, 12.90% (n = 8) had isolated or combined exotropia and 12.90% (n = 8) had isolated strabismus sursoadductorius. Mean preoperative AOD of 15.69 ± 16.91°/15.02 ± 14.88° (near/distance) decreased to 4.00 ± 9.18°/4.83 ± 7.32° (near/distance) at final follow-up (p < 0.001). BCVA improved from 0.26 ± 0.26/0.25 ± 0.23 (left/right) to 0.21 ± 0.25/0.20 ± 0.23 (left/right) (p = 0.038). There was no significant change regarding refractive error (p = 0.109) or elevation in adduction (p = 0.212). Success rate which was defined as a residual AOD of less than 10° was 74.19% (n = 46). In 3.23% (n = 2) retreatment was necessary. CONCLUSION Strabismus surgery in infants was shown to have a satisfactory outcome with a low retreatment rate. Surgical success rate was not linked to age, sex, type of strabismus or the preoperative parameters AOD, refractive error and visual acuity in this study.
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Affiliation(s)
- Laetitia Hinterhuber
- Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Jin K, Aboobakar IF, Whitman MC, Oke I. Mental Health Conditions Associated With Strabismus in a Diverse Cohort of US Adults. JAMA Ophthalmol 2024; 142:472-475. [PMID: 38573646 PMCID: PMC11099685 DOI: 10.1001/jamaophthalmol.2024.0540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/03/2024] [Indexed: 04/05/2024]
Abstract
Importance Greater understanding of the association between strabismus and mental health conditions across sociodemographic backgrounds may inform strategies to improve mental well-being in this population. Objective To describe the association of strabismus with mental health conditions in a diverse cohort of US adults. Design, Setting, and Participants This cross-sectional study used data from the National Institutes of Health's All of Us Research Program, an ongoing program launched in 2015. The study included 3646 adults (aged ≥18 years) with strabismus and 3646 propensity score-matched controls. Statistical analysis was conducted from September 12, 2023, to January 29, 2024. Main Outcomes and Measures Adults with strabismus were propensity score matched on age, gender, race and ethnicity, income, educational level, and insurance status in a 1:1 ratio with adults without strabismus. The prevalences of anxiety, depression, substance use and addiction, bipolar disorder, and schizophrenia spectrum disorder among adults with strabismus were compared with controls. Logistic regression was used to evaluate the association of mental health conditions with sociodemographic factors in each group. Results This study included 3646 adults with strabismus (median age, 67 years [IQR, 53-76 years]; 2017 women [55%]) and 3646 propensity score-matched controls (median age, 67 years [IQR, 53-76 years]; 2017 women [55%]). Individuals with strabismus had higher prevalences of anxiety (1153 [32%] vs 519 [14%]; difference, 17%; 95% CI, 15%-19%; P < .001), depression (1189 [33%] vs 514 [14%]; difference, 19%; 95% CI, 17%-20%; P < .001), substance use and addiction (116 [3%] vs 51 [1%]; difference, 2%; 95% CI, 1%-3%; P < .001), bipolar disorder (253 [7%] vs 101 [3%]; difference, 4%; 95% CI, 3%-5%; P < .001), and schizophrenia spectrum disorder (103 [3%] vs 36 [1%]; difference, 2%; 95% CI, 1%-3%; P < .001) compared with individuals without strabismus. Among adults with strabismus, higher odds of mental health conditions were associated with younger age (odds ratio [OR], 1.11 per 10-year decrease; 95% CI, 1.06-1.16 per 10-year decrease), female gender (OR, 1.62; 95% CI, 1.41-1.85), Black or African American race and ethnicity (OR, 1.22; 95% CI, 1.01-1.48), low income (OR, 3.06; 95% CI, 2.56-3.67), and high school education or less (OR, 1.58; 95% CI, 1.34-1.85). Conclusions and Relevance In a diverse and nationwide cohort, adults with strabismus were more likely to have mental health conditions compared with adults without strabismus. Further investigation into the risk factors for poor mental health among adults with strabismus across sociodemographic backgrounds may offer novel opportunities for interventions to improve mental well-being in this population.
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Affiliation(s)
- Kimberly Jin
- University of Massachusetts Chan School of Medicine, Worcester
| | - Inas F. Aboobakar
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston
| | - Mary C. Whitman
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Isdin Oke
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
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Liu C, Zhao Y, Liu J, Zhao Q. The causal effect of obesity on concomitant exotropia: A lifecourse Mendelian randomization study. Medicine (Baltimore) 2024; 103:e37348. [PMID: 38428888 PMCID: PMC10906616 DOI: 10.1097/md.0000000000037348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024] Open
Abstract
Obesity is now a significant global public health issue. Limited understanding exists regarding the association between obesity and concomitant exotropia. Our objective was to identify the causal relationship between lifecourse obesity, including birth weight, childhood body mass index (BMI), and adult BMI, and the risk of concomitant exotropia. We used a two-sample Mendelian randomization (MR) strategy to examine the causal relationship with inverse-variance weighted method as the primary MR analysis. We carried out sensitivity analyses to evaluate the accuracy and robustness of our findings. Also, we performed reverse-direction MR analysis to eliminate the possibility of reverse causality. Childhood BMI, as opposed to birth weight or adult BMI, had a significant impact on the risk of concomitant exotropia (odds ratio = 1.40, 95% confidence interval (CI): 1.08-1.81, P = .01). This significance persisted even after accounting for birth weight and adult BMI using multivariable MR analysis (odds ratio = 1.35, 95% CI: 1.04-1.75, P = .02). There was no significant heterogeneity or pleiotropy observed in sensitivity analyses (P > .05). Multivariable MR analysis further confirmed the absence of pleiotropic effects of some risk factors including prematurity, maternal smoking around birth and refractive error. Reverse causality did not affect the causal relationship (beta = -0.0244, 95% CI: -0.0545 to 0.0056, P = .11). Genetic predisposition to higher childhood BMI was found to be causally linked to an increased risk of concomitant exotropia.
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Affiliation(s)
- Changyang Liu
- Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Yaxin Zhao
- Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Jiasu Liu
- Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, China
| | - Qi Zhao
- Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, China
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4
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Wei C, Yang DP, Yang Y, Yang WH, Lu YM, Yu XP, Chang S. Visual and auditory attention defects in children with intermittent exotropia. Ital J Pediatr 2024; 50:17. [PMID: 38273409 PMCID: PMC10809432 DOI: 10.1186/s13052-024-01591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Previous studies have shown that children with intermittent exotropia (IXT) have a higher rate of psychiatric abnormalities as they grow up, such as attention deficit. This study explored visual and hearing attention among children with IXT, and evaluated its association with clinical characteristics and cognitive development. METHODS Forty-nine children with a diagnosis of IXT and 29 children with traditional development were recruited. The Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was used to measure the subjects' full-scale response control quotient (FSRCQ), full-scale attention quotient (FSAQ), auditory response control quotient (ARCQ), auditory attention quotient (AAQ), visual response control quotient (VRCQ), and visual attention quotient (VAQ). The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was used to assess their cognitive function. The differences between the scores of children with IXT and normal controls were analyzed. RESULTS The results showed that the FSRCQ, FSAQ, ARCQ, AAQ, VRCQ, and VAQ of children with IXT were all lower than those of normal controls with the same age (P < 0.05). The level of attention was significantly correlated with the age of strabismus onset (P < 0.05), but not with the degree of strabismus, stereopsis, or fusion control score. In addition, audiovisual attention was correlated significantly with their cognitive development level. The random forest classifier prediction model showed that age of strabismus onset was an important predictor of attention. CONCLUSION Children with IXT have lower visual and auditory attention and control than their peers, and the age of onset of strabismus may be a major factor.
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Affiliation(s)
- Cong Wei
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong, China
| | - Ding-Ping Yang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan Yang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen-Han Yang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Ya-Mei Lu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong, China
| | - Xin-Ping Yu
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Shuai Chang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
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5
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Gouveia-Moraes F, Barros S, Vide Escada A, Carreira P, Tardão G, Vaz M, Marques N, Campos N. Strabismus and Health Related Quality of Life in a pediatric Portuguese population. Strabismus 2023; 31:262-270. [PMID: 37973558 DOI: 10.1080/09273972.2023.2276138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Introduction: Strabismus is a common condition among children, and its psychosocial impact has been demonstrated in recent years. The interest in a more comprehensive approach was enhanced by the recognition of health as a four-dimensional concept, arising the term Health-related Quality of Life. Therefore, we aim to evaluate the influence of strabismus in Health-Related Quality of Life of a Portuguese pediatric population. Material and Methods: Case-control prospective transversal study enrolling children between 5 and 12 years old. All had a complete orthoptic and ophthalmological evaluation, followed by an interview with a legal representative to answer the Pediatric Quality-of-Life Inventory 4.0, proxy-version. Results: Seventy-one children were included, 35 in the control group (CG) and 36 in the strabismus group (SG). In the SG, 30 (83.3%) patients had esotropia, 20 (55.6%) had more than 10 prismatic diopters and 26 (72.2%) were already surgically treated. Overall, SG was not statistically different from the CG, showing only mild inferior performance (p > .05). Furthermore, children with exotropia, higher deviations, none or gross stereoacuity and treatment-naïve, scored worse, especially in emotional, social, educational and psychosocial scores although not statistically significant (p > .05). Conclusion: This is the first prospective study addressing HRQoL and strabismus in a pediatric Portuguese population. It would be relevant to further address this issue in order to delineate more effective and global treatment strategies, not only considering ophthalmological goals but also the well-being of both children and guardians.
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Affiliation(s)
| | - Sandra Barros
- Integrated Responsibility Center of Ophthalmology - Garcia de Orta Hospital, Almada
| | - Ana Vide Escada
- Integrated Responsibility Center of Ophthalmology - Garcia de Orta Hospital, Almada
- Department of Pediatric Ophthalmology and Strabismus, Integrated Responsibility Center - Garcia de Orta Hospital, Almada
| | - Pedro Carreira
- Integrated Responsibility Center of Ophthalmology - Garcia de Orta Hospital, Almada
| | - Gonçalo Tardão
- Integrated Responsibility Center of Ophthalmology - Garcia de Orta Hospital, Almada
| | - Mariana Vaz
- Integrated Responsibility Center of Ophthalmology - Garcia de Orta Hospital, Almada
| | - Nadine Marques
- Integrated Responsibility Center of Ophthalmology - Garcia de Orta Hospital, Almada
| | - Nuno Campos
- Integrated Responsibility Center of Ophthalmology - Garcia de Orta Hospital, Almada
- Head of Department of the Integrated Responsibility Ophthalmology Center - Garcia de Orta Hospital, Almada
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Huang TL, Pineles SL. Strabismus and Pediatric Psychiatric Illness: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040607. [PMID: 37189856 DOI: 10.3390/children10040607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE This literature review aims to investigate the potential association between strabismus and mental illness among children. MATERIALS The search was conducted in the PubMed and Google Scholar databases using a wide range of search terms related to strabismus, mental disorders, psychiatric illness, childhood, and adolescence. RESULTS Eleven published studies were included in this review. The findings from this review suggest an association between strabismus and mental illness. Negative attitudes and social bias against children with strabismus were also noted. CONCLUSIONS These findings should alert healthcare providers to counsel children and their caregivers regarding the risk for mood disorders in children with strabismus and to consider mental health screening and referral as needed.
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Affiliation(s)
- Tiffany L Huang
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA 90025, USA
| | - Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA 90025, USA
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7
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Chen L, Sun L, Xue C, Li S, Wang J, Shen X, Gao S, Zhou Z, Xu Y, Huang S, Li Z, Yang X, Guo Y, Zhang W. Refractive errors and ocular findings in children and adolescents with mental disorders: a retrospective study. BMC Ophthalmol 2023; 23:4. [PMID: 36597100 PMCID: PMC9808948 DOI: 10.1186/s12886-022-02704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/24/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An increasing prevalence of mental disorders (MDs) has been reported among children and adolescents. However, only few studies have conducted ocular examinations, including those on refractive status, in these groups of patients. Thus, the purpose of this study was to evaluate the refractive status and ocular findings in children and adolescents with MDs compared with matched controls with similar socioeconomic backgrounds. METHODS A total of 178 participants with MDs and 200 controls were recruited between April 2021 and May 2022. All the children and adolescents underwent cycloplegic or noncycloplegic autorefraction and retinoscopy, slit-lamp biomicroscopy, and dilated fundus examinations. Ocular alignment was assessed using Hirschberg, Krimsky, or prism cover tests. The prevalence of refractive errors and ocular findings was the main outcome. RESULTS Twenty-seven percent of patients with MDs and 8% of controls had ocular findings, the most common of which were conjunctivitis, keratitis, and trichiasis. For refractive status, 70% (124/178) of patients with MDs had myopia ≤-1.00 DS, and 2% (4/178) had hyperopia ≥+2.00 DS. In the control group, 70% (140/200) of patients had myopia ≤-1.00 DS, and 1% (2/200) had hyperopia ≥+2.00 DS. No differences were observed between the MD and control groups. However, the patients in the MD group (14.25±2.69 years) were significantly more susceptible to strabismus (P<0.05) and amblyopia (P<0.01) than those in the control group (13.65±3.04 years). There was a substantial difference between the two groups in the time spent on screen-based devices (P<0.001). Furthermore, mental retardation (OR=3.286, P<0.01), emotional disorders (OR=2.003, P<0.01), and adjustment disorders (OR=2.629, P<0.01) were associated with an increased risk of amblyopia. Depression (OR =1.362, P<0.01) and emotional disorders (OR=2.205, P<0.01) were associated with a higher prevalence of strabismus. CONCLUSION Ophthalmological examinations should be performed in children and adolescents with MDs because MDs are associated with a high prevalence of refractive errors and ocular diseases. Detection and intervention of ocular and refractive findings in children and adolescents with MDs are necessary and effective in alleviating the economic burden in healthcare and improving individuals' quality of life.
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Affiliation(s)
- Liping Chen
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Ling Sun
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.440287.d0000 0004 1764 5550Tianjin Anding Hospital, Tianjin, China ,grid.265021.20000 0000 9792 1228Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Caihong Xue
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shumao Li
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Junjun Wang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Xia Shen
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shiyu Gao
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Zixuan Zhou
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Yuehe Xu
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shaocun Huang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Zhulin Li
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Xiaoyan Yang
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Yatu Guo
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Wei Zhang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
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8
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Li D, Chan VF, Virgili G, Piyasena P, Negash H, Whitestone N, O'Connor S, Xiao B, Clarke M, Cherwek DH, Singh MK, She X, Wang H, Boswell M, Prakalapakorn SG, Patnaik JL, Congdon N. Impact of Vision Impairment and Ocular Morbidity and Their Treatment on Depression and Anxiety in Children: A Systematic Review. Ophthalmology 2022; 129:1152-1170. [PMID: 35660416 DOI: 10.1016/j.ophtha.2022.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 12/17/2022] Open
Abstract
TOPIC 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. CLINICAL RELEVANCE 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. METHODS 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). RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Dongfeng Li
- 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
| | - Ving Fai Chan
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Gianni Virgili
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department NEUROFARBA, University of Florence, Florence, Italy
| | - Prabhath Piyasena
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | | | - Sara O'Connor
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Baixiang Xiao
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | | | - Xinshu She
- School of Medicine, Stanford University, Stanford, California
| | - Huan Wang
- Centre on China's Economy and Institutions, Stanford University, Stanford, California
| | - Matthew Boswell
- Centre on China's Economy and Institutions, Stanford University, Stanford, California
| | - S Grace Prakalapakorn
- Departments of Ophthalmology and Pediatrics and Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Jennifer L Patnaik
- Orbis International, New York, New York; Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Orbis International, New York, New York; Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou City, China.
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Lee YH, Repka MX, Borlik MF, Velez FG, Perez C, Yu F, Coleman AL, Pineles SL. Association of Strabismus With Mood Disorders, Schizophrenia, and Anxiety Disorders Among Children. JAMA Ophthalmol 2022; 140:373-381. [PMID: 35266979 PMCID: PMC8914883 DOI: 10.1001/jamaophthalmol.2022.0137] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Children with strabismus have poorer functional vision and decreased quality of life than those without strabismus. Objective To evaluate the association between strabismus and mental illness among children. Design, Setting, and Participants This cross-sectional study analyzed claims data from the OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, from 12 005 189 patients enrolled in the health plan between January 1, 2007, and December 31, 2017. Eligibility criteria included age 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. Controls were children in the same database with no eye disease codes other than refractive error reported. Demographic characteristics and mental illness claims were compared. Statistical analysis was conducted from December 1, 2018, to July 31, 2021. Main Outcomes and Measures Presence of mental illness claims. Results Among the 12 005 189 patients (6 095 523 boys [50.8%]; mean [SD] age, 8.0 [5.9] years) in the study, adjusted odds ratios for the association of mental illnesses with strabismus were 2.01 (95% CI, 1.99-2.04) for anxiety disorder, 1.83 (95% CI, 1.76-1.90) for schizophrenia, 1.64 (95% CI, 1.59-1.70) for bipolar disorder, 1.61 (95% CI, 1.59-1.63) for depressive disorder, and 0.99 (95% CI, 0.97-1.02) 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 (95% CI, 1.17-1.29) for the association between esotropia and bipolar disorder to 2.70 (95% CI, 2.66-2.74) for the association between exotropia and anxiety disorder. Conclusions and Relevance This cross-sectional study suggests that there was a moderate association between strabismus and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder but not substance use disorder. Recognizing that these associations exist should encourage mental illness screening and treatment for patients with strabismus.
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Affiliation(s)
- Yoon H Lee
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles
| | - Michael X Repka
- Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcy F Borlik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Federico G Velez
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles, Los Angeles.,Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Claudia Perez
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,Department of Biostatistics, University of California, Los Angeles Fielding School of Public Health, Los Angeles
| | - Anne L Coleman
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles
| | - Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,OptumLabs, Eden Prairie, Minnesota
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Wakefield SM, McPherson P. How the Evolving State of Neuroscience Informs the Definition of Adulthood: a Psychiatrist’s Perspective. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2021. [DOI: 10.1007/s40817-021-00116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Choi DD, Park KA, Yang M, Kim S, Roh JH, Oh SY. Association of mental disorders and strabismus among South Korean children and adolescents: a nationwide population-based study. Graefes Arch Clin Exp Ophthalmol 2021; 260:1353-1365. [PMID: 34698906 DOI: 10.1007/s00417-021-05325-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study is to determine the association between mental disorders and strabismus in South Korean children and adolescents. METHODS Using data from the Korean National Health Claims Database from 2011 to 2017, the prevalence rates of mental illnesses and odds ratio were calculated. Children and adolescents (1-19 years) with strabismus and their randomly selected nonstrabismic age- and sex-matched controls (1:1) were enrolled. The odds ratios were adjusted for preterm birth, cerebral palsy, and mental retardation. Subgroup analysis was performed according to sex and the type of strabismus. RESULTS A total of 327,076 subjects (male, 158,597; female, 168,479) identified as strabismus patients were enrolled. After adjusting for preterm birth, cerebral palsy, and mental retardation, the corrected odds ratio of overall mental illness was 1.10 (95% CI, 1.08-1.12) for the strabismus group compared to the controls: 1.7 (95% CI, 1.62-1.78) for developmental disorder, 1.36 (95% CI, 1.27-1.45) for pervasive developmental disorder (autism), 1.14 (95% CI, 1.10-1.17) for attention-deficit hyperactivity disorder (ADHD), 1.15 (95% CI, 1.05-1.27) for obsessive-compulsive disorder (OCD), 1.08 (95% CI, 1.05-1.11) for pediatric behavioral and emotional disorders, 0.93 (95% CI, 0.88-0.99) for post-traumatic stress disorder (PTSD), and 0.85 (95% CI, 0.82-0.89) for tic disorder. CONCLUSION South Korean children and adolescents with strabismus had a higher relative risk for various types of mental disorders such as a developmental disorder, autism, ADHD, and OCD than the controls, whereas they had a relatively lower risk of tic disorder.
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Affiliation(s)
- Daye Diana Choi
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-Ro Gangnam-gu, Seoul, Korea
| | - Mi Yang
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | | | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-Ro Gangnam-gu, Seoul, Korea.
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12
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The impact of strabismus on psychosocial heath and quality of life: a systematic review. Surv Ophthalmol 2021; 66:1051-1064. [PMID: 33773997 DOI: 10.1016/j.survophthal.2021.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
Strabismus can hinder an individual's ability to perform daily functions and negatively affect their well-being. I examine the impact strabismus has on psychosocial health and quality of life in children and adults and evaluate the challenges confronted by parents of children with strabismus. Numerous misconceptions exist regarding the impact strabismus has on overall health. Negative attitudes persist toward those affected, resulting in difficulties with self-image. Individuals with strabismus are at increased risk for both visual system and psychiatric disorders. Misinformation regarding available treatment options for children and adults with strabismus continues to exist, resulting in decreased access to care. Improved education of health care providers can increase appropriate referrals and initiation of treatment. Treatment of strabismus is not merely cosmetic and has the potential to improve psychosocial health and quality of life for children and adults with and without diplopia.
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13
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Estes KJ, Parrish RK, Sinacore J, Mumby PB, McDonnell JF. Effects of corrective strabismus surgery on social anxiety and self-consciousness in adults. J AAPOS 2020; 24:280.e1-280.e4. [PMID: 33038493 DOI: 10.1016/j.jaapos.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To report the results of a questionnaire-based interventional study to evaluate the effects of strabismus surgery on private self-consciousness, public self-consciousness, and social anxiety using a validated self-consciousness survey instrument. METHODS Patients who underwent strabismus surgery completed a demographics and a self-consciousness scale form both pre- and postoperatively. The total and subscale (private self-consciousness, public self-consciousness, and social anxiety) summative scores were compared using the Wilcoxon signed-rank test, with statistically significant relationships defined as P < 0.05. Total and subscale summative scores were analyzed as such and by strabismus type, years of education, and marital status. RESULTS Overall improvement was found postoperatively in total scores (P = 0.012), public self-consciousness scores (P = 0.009), and social anxiety scores (P = 0.028). Although improvement was noted for the private self-consciousness subscale (P = 0.188), it did not reach statistical significance. Subdivided according to strabismic and demographic subgroups, significant improvement was only noted in esotropic patients, college graduates, married/living partner/widowed patients, and separated/divorced patients. CONCLUSIONS This study suggests that beyond functional and cosmetic improvements, strabismus surgery can result in improved public self-consciousness and social anxiety, with greatest effect noted in esotropic, college graduates, and nonsingle patients.
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Affiliation(s)
- Kimberly J Estes
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois.
| | - Rebecca K Parrish
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois
| | - James Sinacore
- Department of Public Heath Science, Loyola University Medical Center, Maywood, Illinois
| | - Patricia B Mumby
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, Maywood, Illinois
| | - James F McDonnell
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois
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Chua AW, Chua MJ, Leung H, Kam PC. Anaesthetic considerations for strabismus surgery in children and adults. Anaesth Intensive Care 2020; 48:277-288. [PMID: 32777929 DOI: 10.1177/0310057x20937710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Strabismus correction surgery is the most common eye operation in children. Adults have approximately a 4% lifetime risk of developing strabismus. Current treatment options include pharmacological injection of botulinum toxin or bupivacaine, conventional corrective surgery, adjustable suture surgery and minimally invasive surgery. Repeated surgery is common as each operation has a 60%-80% chance of successful correction. The benefits of early surgical correction in large-angle strabismus in children outweigh the risks of anaesthesia. General anaesthesia is suitable for patients of all age groups, for complicated or repeated surgery, and bilateral eye procedures. Regional ophthalmic block reduces the incidence of oculocardiac reflex and emergence agitation, and provides postoperative analgesia, but requires a cooperative patient as many experience discomfort. Topical anaesthesia has been used in pharmacological injection, minimally invasive surgery, uncomplicated conventional strabismus surgery and some adjustable suture strabismus surgery. Its use, however, is only limited to cooperative adult patients. Prophylactic antiemesis with both ondansetron and dexamethasone is recommended, especially for children. A multimodal analgesia approach, including paracetamol, intravenous non-steroidal anti-inflammatory drugs, topical local anaesthetic and minimal opioid usage, is recommended for postoperative analgesia, while a supplementary regional ophthalmic block is at the discretion of the team.
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Affiliation(s)
- Alfred Wy Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Matthew J Chua
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Harry Leung
- Department of Ophthalmology, Sydney Children's Hospital, Sydney, Australia
| | - Peter Ca Kam
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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15
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Schuster AK, Elflein HM, Pokora R, Schlaud M, Baumgarten F, Urschitz MS. Health-related quality of life and mental health in children and adolescents with strabismus - results of the representative population-based survey KiGGS. Health Qual Life Outcomes 2019; 17:81. [PMID: 31064363 PMCID: PMC6505127 DOI: 10.1186/s12955-019-1144-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/15/2019] [Indexed: 11/12/2022] Open
Abstract
Background To estimate the effect of strabismus (squinting) on mental health and health-related quality of life aspects in children and adolescents. Methods Data from the German Health Interview and Examination Survey for Children and Adolescents KiGGS (2003–2006 baseline survey; N = 14,835, aged 3 to 17 years, 49% girls) were examined. The presence of strabismus was derived by parental questionnaire, and health-related quality of life and mental health were investigated with the KINDL-R and Strengths and Difficulties Questionnaire. Associations between strabismus and outcomes were analyzed using multivariable linear and logistic regression models. Results Of 12,989 children without missing data, 579 children (4.5% of the sample) were reported to have strabismus. Children with strabismus had lower scores in the parent-reported KINDL-R total scale (adjusted beta = − 1.02; 95%CI: -1.86 to − 0.18; p = 0.018) and sub-scale ‘friends’ (adjusted beta = − 2.18; 95%CI: -3.56 to -0.80; p = 0.002) compared to children without strabismus. The presence of strabismus was also associated with more mental health problems like ‘hyperactivity/inattention’ (adjusted OR = 1.50; 95%CI: 1.14 to 1.98; p = 0.005), and ‘peer problems’ (adjusted OR = 1.35; 95%-CI: 1.05 to 1.74; p = 0.018) as reported by parents. Conclusions Strabismus in children and adolescents is associated with lower health-related quality of life. Electronic supplementary material The online version of this article (10.1186/s12955-019-1144-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | - Heike M Elflein
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Roman Pokora
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin Schlaud
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Franz Baumgarten
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Michael S Urschitz
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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16
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Ye XC, van der Lee R, Wasserman WW. Curation and bioinformatic analysis of strabismus genes supports functional heterogeneity and proposes candidate genes with connections to RASopathies. Gene 2019; 697:213-226. [PMID: 30772522 DOI: 10.1016/j.gene.2019.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/03/2019] [Accepted: 02/01/2019] [Indexed: 12/21/2022]
Abstract
Strabismus refers to the misalignment of the eyes and occurs in 2-4% of individuals. The low-resolution label "strabismus" covers a range of heterogeneous defects, which makes it challenging to unravel this condition. Consequently a coherent understanding of the causes is lacking. Here, we attempt to gain a better understanding of the underlying genetics by combining gene curation, diverse bioinformatic analyses (including gene ontology, pathway mapping, expression and network-based methods) and literature review. Through a phenotype-based curation process, we identify high-confidence and permissive sets of 54 and 233 genes potentially involved in strabismus. These genes can be grouped into 10 modules that together span a heterogeneous set of biological and molecular functions, and can be linked to clinical sub-phenotypes. Multiple lines of evidence associate retina and cerebellum biology with the strabismus genes. We further highlight a potential role of the Ras-MAPK pathway. Independently, sets of 11 genes and 15 loci tied to strabismus with definitive genetic basis have been compiled from the literature. We identify strabismus candidate genes for 5 of the 15 reported loci (CHD7; SLC9A6; COL18A1, COL6A2; FRY, BRCA2, SPG20; PARK2). Finally, we synthesize a Strabismus Candidate Gene Collection, which together with our curated gene sets will serve as a resource for future research. The results of this informatics study support the heterogeneity and complexity of strabismus and point to specific biological pathways and brain regions for future focus.
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Affiliation(s)
- Xin Cynthia Ye
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Robin van der Lee
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Wyeth W Wasserman
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
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Instanes JT, Klungsøyr K, Halmøy A, Fasmer OB, Haavik J. Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review. J Atten Disord 2018; 22:203-228. [PMID: 27664125 PMCID: PMC5987989 DOI: 10.1177/1087054716669589] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To systematically review, synthesize, and appraise available evidence, connecting adult ADHD with somatic disease. METHOD Embase, Psychinfo, and Medline databases were searched for studies published from 1994 to 2015 addressing adult ADHD and somatic comorbidity. Somatic conditions were classified according to International Classification of Diseases (ICD-10) codes. Levels of evidence were graded as inconclusive, tentative, or well documented. RESULTS Most of the 126 studies included in the qualitative synthesis were small and of modest quality. Obesity, sleep disorders, and asthma were well-documented comorbidities in adult ADHD. Tentative evidence was found for an association between adult ADHD and migraine and celiac disease. In a large health registry study, cardiovascular disease was not associated with adult ADHD. CONCLUSION There are few large systematic studies using standardized diagnostic criteria evaluating adult ADHD and somatic comorbidities. Significant associations are found between adult ADHD and several somatic diseases, and these are important to consider when assessing and treating either adult ADHD or the somatic diseases.
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Affiliation(s)
- Johanne Telnes Instanes
- Department of Biomedicine, University of Bergen, Norway,K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Norway,Johanne Telnes Instanes, K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N-5009 Bergen, Norway.
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway,Norwegian Institute of Public Health, Bergen, Norway
| | - Anne Halmøy
- Department of Biomedicine, University of Bergen, Norway,K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Norway,Haukeland University Hospital, Bergen, Norway
| | - Ole Bernt Fasmer
- K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Norway,Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Norway,K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Norway,Haukeland University Hospital, Bergen, Norway
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Abstract
BACKGROUND Children diagnosed with some forms of strabismus were recently found to have an increased risk of developing mental illness by early adulthood. The purpose of this case-controlled study was to determine if adults with non-paralytic forms of strabismus are similarly at an elevated risk for developing mental illness. METHODS The medical records of all patients diagnosed as adults (≥ 19 years of age) with convergence insufficiency (CI) (n = 118), divergence insufficiency (DI) (n = 80), and small angle hypertropia (HT (n = 99) from January 1, 1985, through December 31, 2004, were retrospectively reviewed. Each case was compared with a sex- and birth date-matched non-strabismic control. The medical records were reviewed for mental health diagnoses, including inpatient and outpatient encounters, psychiatric ER visits, and medication use. RESULTS Mental health disorders were diagnosed in 65 (55.1%) patients with CI compared to 54 (45.8%) controls (p = 0.15), in 51 (63.8%) patients with DI compared to 42 (52.5%) controls (p = 0.15), and in 63 (63.6%) patients with HT compared to 57 (57.6%) controls (p = 0.38). CI patients were not more likely to have mental health disorders than their controls (p = 0.15). Mental health hospitalizations (p = 0.02), psychiatric medication use (p = 0.04), and unspecified anxiety disorders (p = 0.03) were higher in DI patients compared to controls. HT patients were found to have more generalized anxiety disorders (p = 0.003) than controls. CONCLUSIONS Adults with some forms of strabismus (DI and HT) appear to have an increased risk of mental illness and its comorbidities, compared to age- and gender-matched non-strabismic controls.
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Abstract
PURPOSE OF REVIEW Adult strabismus can cause many symptoms, which have generally been divided into functional complaints and social complaints. The validity of surgical correction has historically been based on the restoration of functional improvement. In the absence of this expectation, surgery was labeled cosmetic. Yet, many studies have revealed the immense impact of ocular misalignment on psychosocial variables. The purpose of this article is to review the potential functional and psychosocial benefits of strabismus surgery and to summarize the development and status of questionnaires to help quantify these benefits. RECENT FINDINGS Functional benefits of strabismus surgery have been recently summarized with a meta-analysis. Several questionnaires have been evaluated to assess the functional and psychosocial factors in adult strabismus. Two strabismus-specific questionnaires, the Amblyopia and Strabismus Questionnaire and the Adult Strabismus-20, reveal improvements in adults following surgery. The appropriate patient population, impact of comorbidities on the scores, and the timing of the administration of the questionnaire postoperatively still need to be determined. SUMMARY Future studies of the impact of strabismus surgery in adults will need to report not only objective motor results, but also the impact on health-related quality of life to encompass all the benefits of strabismus surgery.
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Surgical correction of childhood intermittent exotropia and the risk of developing mental illness. Am J Ophthalmol 2014; 158:788-792.e1. [PMID: 24954680 DOI: 10.1016/j.ajo.2014.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/13/2014] [Accepted: 06/14/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess whether successful surgical intervention for intermittent exotropia, or the timing of intervention, has any effect on the development of mental illness. DESIGN Retrospective, observational case series. METHODS All patients (<19 years of age) diagnosed with intermittent exotropia in Olmsted County, Minnesota, from January 1, 1975, through December 31, 1994, were reviewed retrospectively. Potential cases were identified using the resources of the Rochester Epidemiology Project, a medical records database designed to capture data on any patient-physician encounter in Olmsted County, Minnesota. The main outcome measures were the occurrence and severity of mental illness among those who underwent strabismus surgery compared with those who did not. RESULTS Ninety-six (52%) of the 184 children identified were diagnosed with a mental illness at a mean age of 23.3 years (range, 6 to 41 years). Thirty-five (36%) of the 96 children in whom mental illness developed underwent strabismus surgery. Success at surgery (<10 prism diopters) was not associated with a decreased occurrence of mental illness (P = .30). Of the 88 patients in whom mental illness did not develop, strabismus surgery was not more commonly performed (P = .54), nor was it performed at a younger age (P = 1.0), when compared with the 96 patients in whom mental illness developed later. CONCLUSIONS Strabismus surgery for children with intermittent exotropia, regardless of success or age at surgery, did not alter the development of mental illness by early adulthood.
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Kassem IS, Miller MT, Archer SM. One Year of Pediatric Ophthalmology and Strabismus Research in Review. Asia Pac J Ophthalmol (Phila) 2013; 2:388-400. [PMID: 26107151 PMCID: PMC6839686 DOI: 10.1097/apo.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To highlight recent advances in amblyopia and strabismus. DESIGN Literature review. METHODS A literature search of articles published in the English language was performed in PubMed or MEDLINE between May 2012 and April 2013 using the terms amblyopia or strabismus. Articles deemed relevant were selected. RESULTS The review highlights articles that increase our understanding of strabismus and amblyopia as well as newer treatment strategies. CONCLUSIONS The review highlights some new information and possible future advances in amblyopia and strabismus.
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Affiliation(s)
- Iris S Kassem
- From the *University of Illinois at Chicago Eye and Ear Infirmary, Chicago, IL; and †Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI
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