Eye Diseases and Mental Health are Linked in Children | AAO 2024

Serious eye conditions are associated with mood disorders, including anxiety, depression, bipolar disorder and schizophrenia, in children and adolescents, according to a presentation at the annual meeting of the American Academy of Ophthalmology (AAO), taking place this weekend in Chicago.

Stacy L. Pineles, M.D.

“Our patients are more than just their eyes, and we have an opportunity to be part of the multidisciplinary medical team talking to our patients about these conditions, as well as asking parents and children if they have any symptoms and providing referrals,” Stacy L. Pineles, M.D., professor of Ophthalmology and Residency Program Director at the Stein Eye Institute, David Geffen School of Medicine at the University of California, Los Angeles, said during the presentation.

Pineles discussed the research of Yoon H. Lee, M.D., now a pediatric ophthalmologist in New York, who conducted an analysis of claims data among children with strabismus. At the time, Lee was doing her residency in the Department of Ophthalmology at Stein Eye Institute, University of California, Los Angeles, Los Angeles.

This found the highest associations are cataract and anxiety and schizophrenia; congenital optic nerve disease and anxiety and schizophrenia; and strabismus (crossing of eyes) and anxiety and schizophrenia.

Lee conducted a cross-sectional review of claims data from OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, of children younger than 19 years of age with strabismus between Jan. 1, 2007, and Dec. 31, 2017.

Strabismus affects between 2% to 5% of children in the United States, or more than 1.5 million children. Children with strabismus often have weaker vision. Patching and eyeglasses can help, but surgery may be needed if the strabismus is not corrected through these efforts.

Lee and her colleagues assessed 352,636 children who had strabismus and 11,652,553 children had no eye disease diagnoses. They assessed five mental illness diagnoses: anxiety disorder, depressive disorder, substance use or addictive disorder, “bipolar disorder” (bipolar and related disorders), and “schizophrenia” (schizophrenia spectrum and other psychotic disorders).

They found that overall, children with strabismus had a higher prevalence of the mental illness diagnoses included, with the exception of substance use disorder. The odds of having a diagnosis of anxiety, depression, bipolar disorder or schizophrenia were higher among children with strabismus than children without.

Lee’s study was published JAMA Ophthalmology in March 2022.

“The risk, especially for anxiety, is increased after multivariate analysis,” Pineles said during the AAO session. “The risk was two times, or an odds ratio of 2.01, for a child to have an anxiety disorder. The odds were also elevated for depression, with a 60% increased risk bipolar and schizophrenia.

Pineles also discussed the research she did along with Elana A. Meer, MBA, M.D., a resident in ophthalmology at University of California, San Francisco. Pineles, Meer and their colleagues assessed the OptumLabs claims of 180,297 children with serious eye diseases, including glaucoma, cataract, congenital optic nerve disease, congenital retinal disease, and blindness/low vision, for an association with mental illness.

They found there was a statistically significant association between having at least one of the five eye diseases and schizophrenia, anxiety, depression and bipolar, but a reversed association with substance use disorder.

They found there was that there was an increased risk of anxiety and schizophrenia, 45% and 54% increased risk, respectively, for a child who had any of these five serious eye diseases. In patients with glaucoma, the risk of anxiety was highest with a 23% increased risk, where 13% of the patients in the database with glaucoma had anxiety versus 6% of patients without any eye diseases. In patients with pediatric cataract, the risk of anxiety was 57% higher, and the risk of schizophrenia was 65% higher.

“The highest associations that we might want to keep in mind are cataract and anxiety and schizophrenia, congenital optic nerve disease and anxiety and schizophrenia, low vision and all of the mental illness conditions that we looked at,” Pineles said.

This study was published in the American Journal of Ophthalmology in August 2022.