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I have an esotropic latent strabismus which causes my left eye to sometimes point inward rather than cooperating with the other eye. I read recently that youths with a strabismus are more likely to develop psychiatric illnesses such as depression and anxiety than the normal population. This piqued my interest since I also suffer from depression and an anxiety disorder. I looked for information to verify what I had found, and discovered that the only study linked on Wikipedia has flaws that leave me questioning the discovery.

After more searching, here's everything I found:

Mental Illness in Young Adults Who Had Strabismus as Children

Surgical Correction of Childhood Intermittent Exotropia and the Risk of Developing Mental Illness

Prevalence and Sex Differences of Psychiatric Disorders in Young Adults Who Had Intermittent Exotropia as Children

Congenital esotropia and the risk of mental illness by early adulthood

These studies all reference the original data, which were gathered from medical records in Olmstead County, Minnesota. My concern is that the sample size is small and that the control was selected in a mystifying manner. It seems odd to limit the control to a 1:1 selection rather than making the control as large as possible. Surely if 407 individuals of a given set of circumstances have a strabismus, a control many times the size of 407 individuals could be used.

I can't find any other studies. Does anyone else have information they can share on whether or not a strabismus increases the likelihood of psychiatric illness? I'm wondering if there's a resource I missed, particularly an article behind a paywall or of similarly restricted access, that could be shared.

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    I'm curious about why do you think this is not a good control group? Do you think controls should be matched by other variables? Which ones? Also, it seems to me that you have found a hole in current knowledge, if no other studies about this subject exist... – tpianca Feb 17 '16 at 21:14
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    @tpianca I edited the question to clarify that the size, not matching, is the issue I have with the control and that the articles I'm looking for are ones I might have missed due to insufficient searching or paywalls. – rhrgrt Feb 18 '16 at 2:00
  • I have access to some post education material on this topic. I'll search it in the next day or two to see what I find. Ping me if I don't get back to you by Monday. – fredsbend Feb 18 '16 at 4:30
  • Another study reports that there is a strong relationship between strabismus and schizophrenia-avehjournal.org/index.php/aveh/article/viewFile/106/74. – pericles316 Feb 18 '16 at 11:03
  • @fredsbend did you have a chance to search for more information? pericles316 Thank you for the extra information. Seems to indicate a shared root, which is interesting. – rhrgrt Feb 23 '16 at 15:49
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Disclaimer: I am neither an optometrist nor vision researcher/specialist. The content I reference are lectures that were given at various COVD conferences for those kinds of professionals. I have no vested interest in any products that promote the sale of treatments for these ailments. I do have a vested interest in the sale of the recorded content of these conference lectures. All the lectures are behind a paywall. Sorry.


Aside from the articles you've already linked and the one in the comments below your question, I cannot find any other studies that correlate Strabismus and Psychological illness. However, I have access to some continuing education material, and I did find information on the following correlations:

  • Vision deficiencies such as strabismus and Neurologic disease (e.g. brain tumors)
  • Convergence insufficiency and ADHD
  • Acquired brain injury presenting vision deficiencies and psychological illness.

Vision deficiencies and neurologic disease

In the lecture The Important Intersection Between Vision Therapy and Neurologic Disease by David A. Damari, OD - Spring 2015 COVD General Education Conference (lecture 4 under General Education), Dr. Damari notes that there is known relationships with certainly visionary issues and Neurologic disease, and urges optometric practitioners to refer them to neurologists, not ophthalmologists. He references two comprehensive sources on the issue:

  • Miller and Newman Walsh & Hoyt's Clinical Neuro-Ophthalmology (The Essentials), LW&W
  • Kline Neuro-Ophthalmology Review Manual, Slack

Convergence Insufficiency and ADHD

In the lecture The Uses of Vision Therapy in Treating School Age Children Diagnosed with Attention Problems by Darrell G. Schlange, OD - Spring 2015 COVD General Education Conference (part of lecture 11, "oral research presentations"), the speaker shows that Convergence Insufficiency (CI) is highly associated with ADHD. CI is somewhat different than Strabismus, however, it is characterized as a binocular visionary disorder whereby the eyes have a tendency to drift outward when working on near field tasks, such as reading, rather than converge the lines of sight for each eye on a single point (source). This, to me, sounds very similar to strabismus, however, strabismus is most often caused by physical deficiencies with the eye, where CI is commonly not associated with physical deficiencies.

Among others, these sources are mentioned and quoted in that lecture:

The lecture Behavioral and Emotional Problems Associated with Convergence Insufficiency in Children by Eric Borsling OD, MS, MSEd - Fall 2012 COVD General Education Conference (lecture 4), corroborates this correlation referencing primarily A Randomized Clinical Trial of Treatments for Convergence Insufficiency in Children (CITT). The conclusions include that a randomized clinical trial is needed to study the impact of successful treatments, children with ADHD should be screened for CI, and children with ADHD may be at higher risk for CI.

Acquired brain injury presenting vision deficiencies and psychological illness

Within the two day workshop Patients with Acquired Brain Injury by Cathy Stern, OD, Dr. Stern notes that a brain trauma can sometimes cause a strabismus, among other vision deficiencies. No source was given, but this was said and accepted by the audience as if it is common knowledge. A quick Google search seems to indicate this as well. However, brain injury is not a psychological issue, though it may bring about psychological issues (i.e. depression, anxiety, etc.). Uncaught brain injury may be causing an increase in the correlation between strabismus and psychological illness. Dr. Stern advises that practitioners take care to isolate genuine brain injury from non-brain injury occurring vision deficiencies. Dr. Stern lists the following sources for the diagnosis and treatment for visual issues stemming from a brain injury:

  • Applied Concepts in Vision Therapy by Leonard J. Press, OD
  • My Stroke of Insight: A Brain Scientist's Personal Journey by Jill Bolte Taylor, PhD
  • Neuro-Optometric Rehabilitation by William V. Padula, OD
  • Visual & Vestibular Consequences of Acquired Brain Injury edited by Irwin D. Suchoff, OD et al.
  • Visual Agnosia by Martha J. Farah
  • I did not take the time to track down links to any of the studies and books mentioned in this answer. I may attempt to later, but if you find some please comment or just edit the post. – fredsbend Feb 24 '16 at 0:08
  • Thanks for the answer. I appreciate your disclaimer. I will take time this weekend to read it more thoroughly. – rhrgrt Feb 26 '16 at 19:09

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