Childhood cataract associated with markedly increased risk of mental disorders: Study

Childhood cataract is a significant cause of visual disability in infancy and early childhood. It is a chronic condition requiring intensive management. Visually disturbing cataracts can be removed by surgery but prolonged and intensive visual and optical rehabilitation is required. Childhood cataract can occur isolated or can be seen in combination with somatic comorbidities that may be associated with neurodevelopmental disorders. Most cases of childhood cataract occur in early childhood, which is also the period of onset of several childhood mental disorders, in particular neurodevelopmental disorders. Children with cataract are more likely to come from a socio-economically disadvantaged background which may further increase the risk of pediatric child mental disorders

The aim of the present study by Moug Al-Bakri et al was to examine the risk of mental disorders in children with childhood cataract compared to children without cataract, using Danish population registries and taking into account potential confounders such as parental socio-economic status, family psychiatric load and the children's somatic comorbidity.

The incidence of mental disorders in children born between 2000-2017 diagnosed with cataract before 10 years of age (N= 485) was compared to sex- and age matched controls (N= 4358). Analyses were corrected to somatic disease in the child and parental socio-economic status and psychiatric morbidity.

The two university hospital setting in Denmark managing children ≤6 years of age with cataract was included.

• The incidence of mental disorders was nearly doubled in children with cataract compared to controls (OR = 1.83 95% CI (1.28 – 3.63)).

• The risk of anxiety disorders was quadrupled (OR = 4.10) and the risk of developmental delay was doubled (OR = 2.66).

• The risk of mental disorders was significantly higher in children diagnosed with cataract in the first 3 years of life compared to controls (OR = 2.36), whereas those diagnosed with cataract later in childhood did not have an increased risk (OR = 1.24).

Authors used nationwide population registries to account for the potential influences of a range of confounders including somatic comorbidities, the socio-economic status of the family, and parental mental disorders. The risk of anxiety disorders was increased more than fourfold, and the risk of neurodevelopmental delay was increased twofold in children with cataract. The risk was highest among children diagnosed with cataract before 3 years of age. In addition, the risk of mental disorders was highest in the group of children who had cataract in combination with systemic disease. Furthermore, mental disorders were increased for those cataract children who have undergone cataract surgery. However, it is difficult to distinguish whether the increased mental disorders is caused by the surgery itself, the visual impairment or the pathology of the cataract.

Severe somatic disease may be directly linked to both development of cataract and presence of mental disease. Study found a doubling of the risk of unspecific developmental delay disorder in children with cataract also in analyses adjusting for diseases with known neuro-developmental comorbidity and diseases in which the treatment involves potential adverse neuro-developmental exposures

The findings highlight the psychological burden on children living with chronic somatic disease. In some situations, the psychological load may influence treatment outcome, as shown in studies of children and adolescents with Type 1 Diabetes Mellitus. Management of childhood cataract often include patching of the better seeing eye to improve vision in the poorer seeing eye (amblyopia treatment). Compliance is essential for visual outcome in amblyopia treatment. Treatment of amblyopia can be associated with a high degree of distress, increased stigma and logistical problems for children and parents.

"In this nationally representative sample, Authors found a markedly higher incidence of developmental disorders and anxiety among children with cataract compared to the background pediatric population. The associations between childhood cataract and mental disorders remained significant even after adjusting for relevant factors such as disease confounders and parental socio-economic status and psychiatric disease. Increased awareness of the mental health burden associated with childhood cataract is important. Routine screening of mental health, e.g. using the Strengths and Difficulties Questionnaire (SDQ) 53 , could guide the support to these children taking into account their mental health as well as overall quality of life, in the visual and optical rehabilitation."

Source: Moug Al-Bakri, Anne Mette Skovgaard , Daniella Bach-Holm, et al, Increased incidence of mental disorders in children with cataract – findings from a population-based study, American Journal of Ophthalmology (2021)

doi: https://doi.org/10.1016/j.ajo.2021.09.034