Impact of Vision Impairment and Ocular Morbidity and Their Treatment on Quality of Life in Children

Abstract

TopicThis review summarizes existing evidence of the impact of vision impairment and ocular morbidity and their treatment on children’s quality of life (QoL).Clinical RelevanceMyopia and strabismus are associated with reduced QoL among children. Surgical treatment of strabismus significantly improves affected children’s QoL.MethodsWe conducted a systematic review and meta-analysis by screening articles in any language in 9 databases published from inception through August 22, 2022, addressing the impact of vision impairment, ocular morbidity, and their treatment on QoL in children. We reported pooled standardized mean differences (SMDs) using random-effects meta-analysis models. Quality appraisal was performed using Joanna Briggs Institute and National Institutes of Health tools. This study was registered with the International Prospective Register of Systematic Reviews (identifier, CRD42021233323).ResultsOur search identified 29 118 articles, 44 studies (0.15%) of which were included for analysis that included 32 318 participants from 14 countries between 2005 and 2022. Seventeen observational and 4 interventional studies concerned vision impairment, whereas 10 observational and 13 interventional studies described strabismus and other ocular morbidities. Twenty-one studies were included in the meta-analysis. The QoL scores did not differ between children with and without vision impairment (SMD, –1.04; 95% confidence interval [CI], –2.11 to 0.03; P = 0.06; 9 studies). Myopic children demonstrated significantly lower QoL scores than those with normal vision (SMD, –0.60; 95% CI, –1.09 to –0.11; P = 0.02; 7 studies). Children with strabismus showed a significantly lower QoL score compared with those without (SMD, –1.19; 95% CI, –1.66 to –0.73; P < 0.001; 7 studies). Strabismus surgery significantly improved QoL in children (SMD, 1.36; 95% CI, 0.48–2.23; P < 0.001; 7 studies). No randomized controlled trials (RCTs) concerning refractive error and QoL were identified. Among all included studies, 35 (79.5%) were scored as low to moderate quality; the remaining met all quality appraisal tools criteria.DiscussionReduced QoL was identified in children with myopia and strabismus. Surgical correction of strabismus improves the QoL of affected children, which supports insurance coverage of strabismus surgery. Further studies, especially RCTs, investigating the impact of correction of myopia on QoL are needed.Financial Disclosure(s)Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. This review summarizes existing evidence of the impact of vision impairment and ocular morbidity and their treatment on children’s quality of life (QoL). Myopia and strabismus are associated with reduced QoL among children. Surgical treatment of strabismus significantly improves affected children’s QoL. We conducted a systematic review and meta-analysis by screening articles in any language in 9 databases published from inception through August 22, 2022, addressing the impact of vision impairment, ocular morbidity, and their treatment on QoL in children. We reported pooled standardized mean differences (SMDs) using random-effects meta-analysis models. Quality appraisal was performed using Joanna Briggs Institute and National Institutes of Health tools. This study was registered with the International Prospective Register of Systematic Reviews (identifier, CRD42021233323). Our search identified 29 118 articles, 44 studies (0.15%) of which were included for analysis that included 32 318 participants from 14 countries between 2005 and 2022. Seventeen observational and 4 interventional studies concerned vision impairment, whereas 10 observational and 13 interventional studies described strabismus and other ocular morbidities. Twenty-one studies were included in the meta-analysis. The QoL scores did not differ between children with and without vision impairment (SMD, –1.04; 95% confidence interval [CI], –2.11 to 0.03; P = 0.06; 9 studies). Myopic children demonstrated significantly lower QoL scores than those with normal vision (SMD, –0.60; 95% CI, –1.09 to –0.11; P = 0.02; 7 studies). Children with strabismus showed a significantly lower QoL score compared with those without (SMD, –1.19; 95% CI, –1.66 to –0.73; P < 0.001; 7 studies). Strabismus surgery significantly improved QoL in children (SMD, 1.36; 95% CI, 0.48–2.23; P < 0.001; 7 studies). No randomized controlled trials (RCTs) concerning refractive error and QoL were identified. Among all included studies, 35 (79.5%) were scored as low to moderate quality; the remaining met all quality appraisal tools criteria. Reduced QoL was identified in children with myopia and strabismus. Surgical correction of strabismus improves the QoL of affected children, which supports insurance coverage of strabismus surgery. Further studies, especially RCTs, investigating the impact of correction of myopia on QoL are needed. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. In 2020, an estimated 596 million people worldwide were affected by distance vision impairment, and a further 510 million had uncorrected near vision impairment.1Bourne R. Steinmetz J.D. Flaxman S. et al.Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study.Lancet Glob Health. 2021; 9: e130-e143Abstract Full Text Full Text PDF PubMed Scopus (475) Google Scholar An estimated 70 million children 0 to 14 years of age have vision impairment, among whom 1.4 million have irreversible blindness.2Burton M.J. Ramke J. Marques A.P. et al.The Lancet Global Health Commission on Global Eye Health: vision beyond 2020.Lancet Glob Health. 2021; 9: e489-e551Abstract Full Text Full Text PDF PubMed Scopus (490) Google Scholar Children with vision impairment often exhibit increased social isolation,3Gray C. Inclusion, impact and need: young children with a visual impairment.Child Care Pract. 2005; 11: 179-190Crossref Scopus (13) Google Scholar elevated risks of mental health problems developing,4Li D. Chan V.F. Virgili G. et al.Impact of vision impairment and ocular morbidity and their treatment on depression and anxiety in children: a systematic review.Ophthalmology. 2022; 129: 1152-1170Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar poor school performance,5Ma X. Zhou Z. Yi H. et al.Effect of providing free glasses on children’s educational outcomes in China: cluster randomized controlled trial.BMJ. 2014; 349: g5740Crossref PubMed Scopus (159) Google Scholar and reduced quality of life (QoL).6Chadha R.K. Subramanian A. 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