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Berlin – Statistically speaking, there is a child in every school class who squints. However, squinting not only has organic effects, but usually also means immense psychosocial suffering for those affected. Why squint operations are so important and when the right time is to correct the misalignment is what Professor Dr. med. Bettina Wabbels will report on October 10, 2024 at the hybrid press conference at the annual congress of the German Ophthalmological Society (DOG).

Around four percent of the population in Germany squint. Sometimes people only start squinting in adulthood – for example due to a stroke, an accident or a thyroid disease. “But that is rather rare, most forms of squint begin in childhood,” explains Professor Dr. med. Bettina Wabbels, head of orthoptics, neuro- and pediatric ophthalmology at the University Eye Clinic in Bonn. It is estimated that one in 25 children squints. “In principle, there is an affected child in every class,” says Wabbels.

When you squint, also known as strabismus, one eye deviates from the line of sight of the other eye. This can cause double vision, reduced spatial vision or headaches, and in children even loss of vision on one side. “However, the psychosocial consequences are at least as serious,” emphasizes the DOG expert. Studies show: People who squint are perceived by those around them as less intelligent, likeable, attractive and hardworking, which can lead to disadvantages in everyday life, school and work, as well as in choosing a partner and consequently also to a reduced quality of life.¹

This causes psychological suffering. “Squinting can lead to shame, avoidance behavior, social withdrawal or mental problems in children and adults,” reports Bettina Wabbels. “These aspects of squinting have so far been underestimated, although they are extremely important for those who squint,” emphasizes the Bonn ophthalmologist. People who squint are often particularly unsettled when it comes to eye contact. “Those affected report that they have difficulties in interpersonal communication; that they are even accused of being dishonest or inattentive and of not listening because their gaze wanders,” says Wabbels. Some sufferers try to conceal their squinting with hairstyles or head positions or do not even look their counterpart in the eye, which tends to make interaction problems even worse. The DOG expert’s tip: “Look at the bridge of the other person’s nose.”

A strabismus operation offers relief – it not only improves the interaction between both eyes, but also the psychosocial situation by helping to increase social acceptance and attractiveness. The University Eye Clinic in Bonn has already been able to demonstrate a positive influence of strabismus operations on quality of life in a pilot study.² “After the squint operation, the symptoms of anxiety and depression fell below the threshold of needing treatment,” Wabbels summarizes. “Many expressed their extreme gratitude that they could finally openly discuss these stressful problems – they often said that the squint had affected their entire lives.”

Now these factors are to be examined for the first time in a large multicenter study (“QUALITAS – Quality of life after strabismus surgery”) under the direction of the University Eye Clinic in Bonn over a period of six years on more than 1,000 adult strabismus patients. “Among other things, we want to measure the influence of strabismus surgery on quality of life and mental health,” says Wabbels. At the same time, identifying patients with depressive symptoms and anxiety offers the opportunity to refer those affected to suitable treatment options.

Not least against this background, it is important to continue to adequately finance squint operations in the future. The right time to operate on a child is usually between the ages of four and six. “It is only from preschool age that children can recognize that another child is squinting,” says Wabbels.³ There are no studies on the frequency of bullying among children. “But the teasing usually starts at primary school age,” says the ophthalmologist. The misalignment should ideally be corrected before starting school.

Literature:

1. Adams GG, McBain H, MacKenzie K, Hancox J, Ezra DG, Newman SP. Is strabismus the only problem? Psychological issues surrounding strabismus surgery. J AAPOS 2016; 20:383-386
2. Ehlers M, Mauschitz MM, Wabbels B. Implementing strabismus-specific psychosocial questionnaires in everyday clinical practice: mental health and quality of life in the context of strabismus surgery; BMJ Open Ophthalmology 2023;8:e001334.
3. Mojon-Azzi SM, Kunz A, Mojon DS. Strabismus and discrimination in children: are children with strabismus invited to fewer birthday parties? The British journal of ophthalmology 2011; 95: 473-476

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