The aim of this study is to determine the association between mental disorders and strabismus in South Korean children and adolescents.
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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Chew E, Remaley NA, Tamboli A, Zhao J, Podgor MJ, Klebanoff M (1994) Risk factors for esotropia and exotropia. Arch Ophthalmol 112(10):1349–1355
Graham PA (1974) Epidemiology of strabismus. Br J Ophthalmol 58(3):224–231
Yoon KC, Mun GH, Kim SD, Kim SH, Kim CY, Park KH, Park YJ, Baek SH, Song SJ, Shin JP, Yang SW, Yu SY, Lee JS, Lim KH, Park HJ, Pyo EY, Yang JE, Kim YT, Oh KW, Kang SW (2011) Prevalence of eye diseases in South Korea: data from the Korea national health and nutrition examination survey 2008–2009. Korean J Ophthalmol 25(6):421–433. https://doi.org/10.3341/kjo.2011.25.6.421
Han KE, Baek SH, Kim SH, Lim KH, Epidemiologic Survey Committee of the Korean Ophthalmological S (2018) Prevalence and risk factors of strabismus in children and adolescents in South Korea: Korea national health and nutrition examination survey, 2008–2011. PLoS ONE 13(2):e0191857. https://doi.org/10.1371/journal.pone.0191857
Schiffman J, Maeda JA, Hayashi K, Michelsen N, Sorensen HJ, Ekstrom M, Abe KA, Chronicle EP, Mednick SA (2006) Premorbid childhood ocular alignment abnormalities and adult schizophrenia-spectrum disorder. Schizophr Res 81(2–3):253–260. https://doi.org/10.1016/j.schres.2005.08.008
Toyota T, Yoshitsugu K, Ebihara M, Yamada K, Ohba H, Fukasawa M, Minabe Y, Nakamura K, Sekine Y, Takei N, Suzuki K, Itokawa M, Meerabux JM, Iwayama-Shigeno Y, Tomaru Y, Shimizu H, Hattori E, Mori N, Yoshikawa T (2004) Association between schizophrenia with ocular misalignment and polyalanine length variation in PMX2B. Hum Mol Genet 13(5):551–561. https://doi.org/10.1093/hmg/ddh047
Olson JH, Louwagie CR, Diehl NN, Mohney BG (2012) Congenital esotropia and the risk of mental illness by early adulthood. Ophthalmology 119(1):145–149. https://doi.org/10.1016/j.ophtha.2011.06.035
Mohney BG, McKenzie JA, Capo JA, Nusz KJ, Mrazek D, Diehl NN (2008) Mental illness in young adults who had strabismus as children. Pediatrics 122(5):1033–1038. https://doi.org/10.1542/peds.2007-3484
McKenzie JA, Capo JA, Nusz KJ, Diehl NN, Mohney BG (2009) Prevalence and sex differences of psychiatric disorders in young adults who had intermittent exotropia as children. Arch Ophthalmol 127(6):743–747. https://doi.org/10.1001/archophthalmol.2009.68
Lukman H, Kiat JE, Ganesan A, Chua WL, Khor KL, Choong YF (2011) Negative social reaction to strabismus in school children ages 8–12 years. J AAPOS 15(3):238–240. https://doi.org/10.1016/j.jaapos.2011.01.158
Durnian JM, Owen ME, Marsh IB (2009) The psychosocial aspects of strabismus: correlation between the AS-20 and DAS59 quality-of-life questionnaires. J AAPOS 13(5):477–480. https://doi.org/10.1016/j.jaapos.2009.06.006
Nelson BA, Gunton KB, Lasker JN, Nelson LB, Drohan LA (2008) The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction. J AAPOS 12(1):72-76.e71. https://doi.org/10.1016/j.jaapos.2007.08.006
McBain HB, MacKenzie KA, Hancox J, Ezra DG, Adams GG, Newman SP, Medscape (2016) Does strabismus surgery improve quality and mood, and what factors influence this? Eye (Lond) 30(5):656–667. https://doi.org/10.1038/eye.2016.70
Hwang S, Lim DH, Chung TY (2018) Prevalence and incidence of keratoconus in South Korea: a nationwide population-based study. Am J Ophthalmol 192:56–64. https://doi.org/10.1016/j.ajo.2018.04.027
Park SJ, Kwon KE, Choi NK, Park KH, Woo SJ (2015) Prevalence and incidence of exudative age-related macular degeneration in South Korea: a nationwide population-based study. Ophthalmology 122 (10):2063–2070 e2061. doi:https://doi.org/10.1016/j.ophtha.2015.06.018
Abel KM, Wicks S, Susser ES, Dalman C, Pedersen MG, Mortensen PB, Webb RT (2010) Birth weight, schizophrenia, and adult mental disorder: is risk confined to the smallest babies? Arch Gen Psychiatry 67(9):923–930. https://doi.org/10.1001/archgenpsychiatry.2010.100
Nomura Y, Brooks-Gunn J, Davey C, Ham J, Fifer WP (2007) The role of perinatal problems in risk of co-morbid psychiatric and medical disorders in adulthood. Psychol Med 37(9):1323–1334. https://doi.org/10.1017/S0033291707000736
Kerker BD, Owens PL, Zigler E, Horwitz SM (2004) Mental health disorders among individuals with mental retardation: challenges to accurate prevalence estimates. Public Health Rep 119(4):409–417. https://doi.org/10.1016/j.phr.2004.05.005
Holmstrom G, el Azazi M, Kugelberg U (1999) Ophthalmological follow up of preterm infants: a population based, prospective study of visual acuity and strabismus. Br J Ophthalmol 83(2):143–150
Collins ML (2014) Strabismus in cerebral palsy: when and why to operate. Am Orthopt J 64:17–20. https://doi.org/10.3368/aoj.64.1.17
Caputo R, Tinelli F, Bancale A, Campa L, Frosini R, Guzzetta A, Mercuri E, Cioni G (2007) Motor coordination in children with congenital strabismus: effects of late surgery. Eur J Paediatr Neurol 11(5):285–291. https://doi.org/10.1016/j.ejpn.2007.02.002
Dusek WA, Pierscionek BK, McClelland JF (2011) An evaluation of clinical treatment of convergence insufficiency for children with reading difficulties. BMC Ophthalmol 11:21. https://doi.org/10.1186/1471-2415-11-21
Dusek W, Pierscionek BK, McClelland JF (2010) A survey of visual function in an Austrian population of school-age children with reading and writing difficulties. BMC Ophthalmol 10:16. https://doi.org/10.1186/1471-2415-10-16
Ikeda J, Davitt BV, Ultmann M, Maxim R, Cruz OA (2013) Brief report: incidence of ophthalmologic disorders in children with autism. J Autism Dev Disord 43(6):1447–1451. https://doi.org/10.1007/s10803-012-1475-2
Kabatas EU, Ozer PA, Ertugrul GT, Kurtul BE, Bodur S, Alan BE (2015) Initial ophthalmic findings in turkish children with autism spectrum disorder. J Autism Dev Disord 45(8):2578–2581. https://doi.org/10.1007/s10803-015-2428-3
Merdler I, Giladi M, Sorkin N, Shapira S, Galili E, Margulis A, Korach T, Hassidim A (2017) Strabismus and mental disorders among Israeli adolescents. J AAPOS 21(3):185–189. https://doi.org/10.1016/j.jaapos.2017.04.001
Bloch MH, Panza KE, Landeros-Weisenberger A, Leckman JF (2009) Meta-analysis: treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders. J Am Acad Child Adolesc Psychiatry 48(9):884–893. https://doi.org/10.1097/CHI.0b013e3181b26e9f
Lowe TL, Cohen DJ, Detlor J, Kremenitzer MW, Shaywitz BA (1982) Stimulant medications precipitate Tourette’s syndrome. JAMA 247(12):1729–1731
Albin RL (2006) Neurobiology of basal ganglia and Tourette syndrome: striatal and dopamine function. Adv Neurol 99:99–106
Kang SL, Shaikh AG, Ghasia FF (2018) Vergence and strabismus in neurodegenerative disorders. Front Neurol 9:299. https://doi.org/10.3389/fneur.2018.00299
Santangelo SL, Pauls DL, Goldstein JM, Faraone SV, Tsuang MT, Leckman JF (1994) Tourette’s syndrome: what are the influences of gender and comorbid obsessive-compulsive disorder? J Am Acad Child Adolesc Psychiatry 33(6):795–804. https://doi.org/10.1097/00004583-199407000-00004
Satterfield D, Keltner JL, Morrison TL (1993) Psychosocial aspects of strabismus study. Arch Ophthalmol 111(8):1100–1105. https://doi.org/10.1001/archopht.1993.01090080096024
Hatt SR, Leske DA, Kirgis PA, Bradley EA, Holmes JM (2007) The effects of strabismus on quality of life in adults. Am J Ophthalmol 144(5):643–647. https://doi.org/10.1016/j.ajo.2007.06.032
Wen G, McKean-Cowdin R, Varma R, Tarczy-Hornoch K, Cotter SA, Borchert M, Azen S, Multi-ethnic Pediatric Eye Disease Study G (2011) General health-related quality of life in preschool children with strabismus or amblyopia. Ophthalmology 118(3):574–580. https://doi.org/10.1016/j.ophtha.2010.06.039
Lin S, Congdon N, Yam JC, Huang Y, Qiu K, Ma D, Chen B, Li L, Zhang M (2014) Alcohol use and positive screening results for depression and anxiety are highly prevalent among Chinese children with strabismus. Am J Ophthalmol 157(4):894-900.e891. https://doi.org/10.1016/j.ajo.2014.01.012
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology(2018R1D1A1B07043958) to SYO.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Samsung Medical Center Institutional Review Board and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
The requirement for informed consent from the individual patients was waived because the data used were public and anonymized under confidentiality guidelines.
Conflict of interest
The authors declare no competing interests.
The funders had no role in study design, data collection, and analysis, decision to publish or preparation of the manuscript.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Choi, D.D., Park, KA., Yang, M. et al. Association of mental disorders and strabismus among South Korean children and adolescents: a nationwide population-based study. Graefes Arch Clin Exp Ophthalmol (2021). https://doi.org/10.1007/s00417-021-05325-7
- Mental illness
- Autism; ADHD
- Developmental disorder
- Obsessive compulsive disorder