Children whose eyes are misaligned and point outward are at significantly increased risk of developing mental illness by early adulthood, according to findings of a Mayo Clinic study published this month in Pediatrics, the official journal of the American Academy of Pediatrics.
The retrospective study examined the medical records of 407 patients with strabismus and compared them with those of children matched for age and sex but with normal eye alignment. Children with eyes that diverged (exotropia) were three times more likely to develop a psychiatric disorder than were the control subjects, while those with inward deviating eyes (esotropia) showed no increase in the incidence of mental illnesses.
Brian Mohney, M.D., the Mayo Clinic pediatric ophthalmologist who led the study, describes the research findings and the observation that caused the study to be conducted:
Attention Journalists: You may embed the YouTube video above in your stories, or may click this link to download a video file that you can edit.
I would be curious to see what the actual numbers were. The article said “children with eyes that diverged (exotropia) were three times more likely to develop a psychiatric disorder than were the control subjects”. So 4 times as many children with exotropia had a psychiatric disorder than those without? Or was it really three times AS likely?
I am functionally a one-eyed person with a spare eye. I had surgery to remedy the outward symptoms of exotropia- on both eyes, one around age 5 and the other around age 11. What remains unchanged nearly 50 years later is the complete absence of stereo vision and normal depth perception; even though my eyes are aligned, the corresponding visual centers in my brain missed their only opportunity to develop connections. If I look through binoculars or a stereo microscope, I am aware of seeing two separate images. In ordinary life, I live in a flat world.
For photography, this can be an advantage of sorts- but for just walking around, there are situations when it is quite unnerving to be forced to navigate three dimensions with a visual system that handles only two.
Technology offers some vocabulary to help explain how it is to have a streaming video buffer overrun happen in my brain- the picture hangs and lags, but the sound continues smoothly on. If I’m skiing, I know to simply drop onto the snow: the tree that I thought was over THERE may possibly be right HERE. To a conventionally-sighted onlooker, this probably looks awfully odd…
Esotropia would not so preclude development of optic-center connections that allow stereo vision and a full experience of the three dimensional world.
What I wonder about folks with exotropia: is the documented greater risk of psychiatric illness related more to an inner disconnect (eye and brain), or an outer one (world and brain)? -is surgical repair now followed up with support for adapting to a very different visual experience of the world?
Thanks for your comments. If you want to see the actual numbers, they are linked to the journal article in the first paragraph of the story, but here is the link also:
http://pediatrics.aappublications.org/cgi/content/full/122/5/1033
This is an interesting study that has the potential to negatively affect the lives of thousands of adults or children. Taken out of context strabismus could end up being used as a differential hiring criteria between to superficially qualified candidates. The bias potential is already there within the the society.
Further research is needed on the neurological significance referenced in the previous description of connectivity. However, more importantsly to avoid the social stigma of this research it is even more important that children recieve immediate and aggressive care for the cosmetic value.
This is very interesting. My husband had surgery for a “lazy eye” when he was 26. I don’t know if a lazy eye and strabismus are the same thing, but it kind of made me go “hmmm…”, as he is now bipolar.
I am going thru a time with a 14 year old – whom was born preemie and now has developed Intermittent exotropia – so say say mental illness – well if you only knew what my child has gone thru when nobody understands -and in school all he gets is torment by teachers and labelled – teased by classmatess, being tripped sticking a foot out becasue he cant see , stealing his glasses from him – what do you think this would do to you as a child, cant play sports being you cannot see the ball coming at you!
Mental illness – interesting – now he has another battle to fight – may as well give up being your labelled in all directions!
My wife of 43 years had a lazy eye as a child and a frontal head injury at 16. Not long in our marriage she seemed to have two personalities and the last 5 years of our marriage she was actually evil in the things she did and said to me. She divorced me 6 years ago and I have discovered thing that she did that i had been unaware of before.
We have some contact now because of our children and grandchildren. She at times seems very nice easy going and religious and other times hatefull. Some others have asked me about her when they had contact with her.
She is now 69 years old and most of the time seems normal. Any ideas on this ??
Thank you for your comment, but, unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If she would like to seek help from Mayo Clinic, the best way to do it is to call one of our appointment offices:
Mayo Clinic, Jacksonville Fla., (904) 494-6487
Mayo Clinic, Rochester Minn., (507) 322-3555
Mayo Clinic, Scottsdale, Ariz., (480)422-1646
You also can visit our Web site, http://www.mayoclinic.org/patientinfo/appointments.html
or have your doctor call our Referring Physician’s Service, http://www.mayoclinic.org/medicalprofs/
You do not need a doctor’s referral, although information about past treatment is always important.
My daughter has been diagnosed with exotropia/strabismus since she was about 18 months old. She was assigned a glasses prescription (they were demolished within a week) and I was warned that surgery might be necessary by her 4th birthday. She’s absolutely gorgeous, stunningly so with bright blue/grey eyes, creamy brown skin and curly brown/blonde hair. Her personality and size brings many to initially think she is older than her nearly three years. As a mother, I feel like I have been blessed. Some of the issues that more homely girls may face with the added assault of a wandering eye have evaded us. However, I have worked with children my daughter’s age while employed in child care centers and I know my child is different, not just smarter and more beautiful, than the rest. I have always worried that she had some sort of mental issues in association with her episodes of exotropia, but have been reluctant to send her to a mental specialist because of the harm that could cause to her psyche (she is so young and I have heard that early exposure to head doctors could have a negative effect on a child’s performance and self-esteem). But, this news about exotropia and strabismus relating to mental illness is making me think we need to make an appointment with a psychiatrist. Is it common or advised to send a preschooler to a shrink?
This a good question; we have not been sure how to approach this finding. However, it’s not clear from your note which form of “exotropia” your child has and her particular form may not be at risk. Nevertheless, I would recommend you contact her primary care physician to make recommendations for psychology/psychiatry consultation or not. For
more information, see email sent directly. Brian Mohney, M.D.
I have seen this in two generations of one family. It is clear that both individuals are deeply disturbed. One of those individuals also has obvious genetic issues. These two are grandparent and grandchild.
I hope you will do further research regarding inbreeding in relation to eye divergence/mental illness. Certain populations are known to have inbred extensively, and I believe there is a connection/ This particular family is also affected by FAS through the generations, which could be another consideration for the future.
Why not research the connection between the perceptual tweaking and impaired information processing that occurs when a child grows up with his vision altered and distorted, and the various mental illnesses that, it could be argued, are also perceptual in nature as well as in how they are manifested through their symptomology?
Strabismus is definitely a physical condition, which among everything else it does changes how one perceives and takes in and processes information. Now that there is a connection being established between kids with these visual differences and the increased incidence of mental illness, wouldn’t you think that its time to investigate the possible connection between visual disturbances, impaired perception via impaired vision, and mental illness?
Don’t the results of this study point to schizophrenia and other mental illnesses being related to perceptual /visual and information intake and processing problems as much as it does anything else?
Can one induce schizophrenia- like symptoms by altering the way one perceives and processes information taken in visually by the eye?
What exactly happens to information processing when one’s environment and expereinces are filtered through a distorted or warped visual field?
Thank you for your question. We will inquire.