The authors present a retrospective cohort study with the aim of assessing the association between strabismus surgery in early childhood and psychiatric diagnosis incidence. An international healthcare records platform was utilised to access electronic medical records from 92 healthcare organisation. All cases needed to have been diagnosed with strabismus before the age of five years old, had strabismus surgery before 18 years old and had data recorded between 2003–2013. Extensive exclusion criteria were applied including pre-existing mental health problems and other conditions which could result in negative psychosocial outcomes, e.g. speech disabilities, congenital malformations. From those meeting these criteria two cohorts were created. The first had surgery prior to or at age six and had no subsequent surgery, and the second group had surgery delayed for over 12 months after diagnosis at or after age seven. Data were extracted using ICD10 codes. A total of 1400 cases were identified to meet the inclusion criteria. The cohort who had earlier strabismus surgery were reported to have significantly less psychiatric diagnoses than the second cohort who had delayed surgery (p<0.0001). The risk was also significantly higher for males in the delayed surgery group (p=0.0006). Depressive disorder was the only psychiatric diagnosis which did not have a significant difference between the two cohorts, whereas anxiety disorders, attention deficit hyperactivity disorder, conduct disorders and adjustment disorder were all reported in greater numbers within the delayed surgery cohort. Limitations of the study include exclusion of children with strabismus diagnosed early but never had strabismus surgery in childhood, and the propensity scoring did not account for factors such as socioeconomic status, family history of mental health or strabismus severity. Whilst an association has been established by this study, more questions about whether psychiatric disorders are a result of delayed surgery or are the drive for the decision to delay surgery. Further research is required in this area.
