Impact of vision impairment and ocular morbidity and their treatment on quality of life in children: a systematic review.

TOPIC: This review summarizes existing evidence on the impact of vision impairment and ocular morbidity and their treatment on children's quality of life (QoL).

CLINICAL RELEVANCE: Myopia and strabismus are associated with reduced QoL among children. Surgical treatment of strabismus significantly improves affected children's QoL.

METHODS: We conducted a systematic review and meta-analysis by screening articles in any language in nine databases published from inception through August 22, 2022, for publications 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 done with the Joanna Briggs Institute (JBI) and American National Institutes of Health (NIH) tools. This study was registered with PROSPERO, number CRD42021233323.

RESULTS: Our search identified 29 118 articles, of which 44 studies (0.15%) were included for analysis and included 32 318 participants from 14 countries between 2005 and 2022. Seventeen observational and four interventional studies concerned vision impairment, while 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. (standard mean difference [SMD]5, -1.04; 95% confidence interval [CI], -2.11, -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, -0.11, p=0.02, 7 studies). Children with strabismus showed a significantly lower QoL score compared to those without (SMD, -1.19; 95% CI, -1.66, -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 concerning refractive error and QoL were identified in this review. Among all included studies, 35 (79.5%) scored as low to moderate quality, the remaining met all quality appraisal tools criteria.

CONCLUSION: 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 randomized controlled trials, investigating the impact of correction of myopia on QoL are needed.