Strabismus in animation: study highlights harmful stereotypes in children's films

(Image credit: Adobe Stock/Lena May)

Strabismus, a misalignment of the eyes that is most often diagnosed in pediatric patients, does not impact an individual’s personality or intelligence, but a study has found that animated movies often tend to use the condition to signify a clumsy, dopey or villainous character, according to a study by researchers at the University of Colorado School of Medicine.¹

Michael Puente, MD, an assistant professor of ophthalmology who focuses on pediatric ocular health, pointed out that when animators are determining just what a character is going to look like, they have to decide on every little detail of that character's appearance, and so it's not by chance that an animated character happens to have strabismus.

“That's something that the animation team made a deliberate decision to do, and I imagine that they have reasons for that decision,” he said. “Our study suggests that commonly, the reason that a character is depicted as having strabismus is if that character is unintelligent or undesirable, and that animators see strabismus as a way of visually conveying that undesirable trait.”

According to the study, published this month in the journal Pediatrics, the researchers analyzed reviewed all animated films released by Walt Disney Animation Studios from 1989 to 2022 and all films released by Pixar, DreamWorks, and Studio Ghibli before 2023 and identified all characters with strabismus. Five raters each independently performed a character trait analysis of all characters with strabismus, and a sample proportion test was used for statistical comparison of these traits.^1,2

The researchers found characters with strabismus were 14 times more likely to be depicted as unintelligent than intelligent and 6 times more likely to be followers than leaders. These depictions, the researchers say, can have harmful effects for children with strabismus by perpetuating stereotypes that can negatively affect a patient’s self-confidence and influence the perception of strabismus by young impressionable audiences.

Strabismus in mental development

Strabismus can present as crossed eyes or one eye drifting outward. In some young patients, strabismus may signal a need for corrective lenses, while in others, it indicates a neurological issue where the brain's signals to the eye muscles are miscalibrated, causing some muscles to pull too strongly or too weakly.

Surgical intervention can help address these muscle imbalances, with success rates of approximately 80%, according to Puente. He frequently encounters young patients who request surgery due to concerns about their appearance.

“Every day, I have children asking me for surgery, which speaks volumes, as kids are generally apprehensive about medical procedures,” Puente noted. “Strabismus often impacts these children to such a degree that they’re proactively seeking a solution. I don’t think many pediatric surgeons have this experience.”

While strabismus can hinder a child’s visual development, its impact extends beyond the eyes, affecting how children interact with peers, teachers, and society at large.

“Unfortunately, kids with strabismus are often the targets of bullying due to the difference in their appearance,” Puente explained. “Studies have shown that children with strabismus are less likely to be invited to birthday parties, and classmates may be reluctant to sit next to them. Teacher surveys have revealed that educators often assume children with strabismus are less intelligent, and these stereotypes can have a lasting impact on a child’s psychosocial development.”

Media depictions and impact on perception

Negative portrayals in media can exacerbate these stereotypes, according to Puente and his fellow researchers. In their study of 125 films and 46 characters with strabismus, they found that positive, leading characters with this condition were virtually nonexistent. While there were a few characters with strabismus who were depicted as leaders, one was a villain, and another was portrayed as “unintelligent.” The only character considered "intelligent" was Forrest Woodbush, from Pixar's The Good Dinosaur^.1,2

Puente said hopes that these findings will raise awareness about the prevalence of negative portrayals in children's media and encourage animators to consider the impact of these depictions on young audiences.

“If animators recognize the tendency to portray strabismus negatively, I hope they’ll rethink how they represent characters with this condition,” Puente said. “When creating a villain or a ‘dumb’ character, they might pause before choosing to give them strabismus. Such portrayals send a message to impressionable viewers.”

“There are many people with strabismus, and it would be powerful to see positive role models with this condition in media,” he continues. “Unfortunately, none of the characters in our study were portrayed in this way, but I believe that making this change would have a significant and positive impact.”

Norman B. Medow, MD, FACS, director, Pediatric Ophthalmology and Strabismus, Montefiore Hospital Medical Center, a professor of Ophthalmology and Pediatrics at Albert Einstein College of Medicine, and a member of the Ophthalmology Times Editorial Advisory Board, noted that he has never had a patient with strabismus mention any animated characters.

“I think that children that watch these cartoons do not note this issue and if parents of children that have strabismus do, they most likely do not talk to their children about it,” he noted.

Medow added the animators should learn their perceptions of strabismus as being present in characters that are dull, dumb or have an intellectual issue are not in step with the perceptions of the viewers of their works.

Positive role models

During the 2024 Olympic Games in Paris, the “Clark Kent” of men’s gymnastics, Stephen Nedoroscik, become an overnight sensation.

Nedoroscik was part of the US men’s gymnastics team that claimed a bronze medal on July 29, 2024, thanks in large part to his performance on the pommel horse. Viewers noticed Nedoroscik with his thick black frames, sitting quietly on the sidelines ahead of his event. He competes with strabismus and coloboma.³

Terri A. Gossard, OD, MS, the national medical director of clinical integration for EyeCare Partners, noted that strabismus usually presents early in childhood but it can develop later in life.

“There's all different kinds of strabismus,” she said. “You can have a very, very obvious eye turn. Essentially, strabismus is when your eyes aren't pointed at the same direction, so they're misaligned. It can be one eye that is completely off-center. It could be a very small strabismus that isn't always visible to the naked eye. It could be something that alternates, and I think that is the case in Stephen’s instance where he can decide which eye he's using to fixate.”

Nedoroscik, who currently is competing on Dancing with the Stars, a celebrity dance competition on ABC, was seemingly able to compete in the Olympics with what appeared to be no difficulty. Gossard believes that practice mixed with visualization helped him dominate the pommel horse.

Moreover, as the gymnast-turned dancer has brought more awareness to both conditions, Gossard noted that people should look for the obvious signs of these problems, especially in children.

“We really recommend that you have your child's visual system evaluated in the first year of life,” Gossard said. “And then depending on what you see there at the eye doctor and what the family history of the child is, – between the ages of three and five – it’s important for the development of the eyes and the visual system. I talked about that amblyopia; we certainly don't want that to happen. It's also setting up them to up to succeed in school and in sports, and apparently the Olympics.”

Other famous people who were diagnosed with strabismus include US presidents John F. Kennedy and Abraham Lincoln; Academy Award-winning actors Russell Crowe and Denzel Washington; model Kate Moss; actor Ryan Gosling; actress Kristen Bell; socialite/actress Paris Hilton; as well as actors Paul Dano, Zac Efron and Taylor Lautner; and singer Barbra Streisand.^4,5

References

1. Michael A. Puente, MD; Jintong Liu, BS; Aditya Mantha, BA; Tyler D. Benjamin, MM; et.al. Depictions of Strabismus in Children’s Animated Films. Pediatrics. Published November 11, 2024. Accessed November 13, 2024. DOI: https://doi.org/10.1542/peds.2024-067355

2. Kara Mason. Animated movie characters with stabismus are more likely to be villains, study finds. University of Colorado. Published November 12, 2024. Accessed November 13, 2024.

3. Koennecke G. Stephen Nedoroscik brings awareness to strabismus, coloboma at the 2024 Olympic Games. Ophthalmology Times. Published August 3, 2024. Accessed November 15, 2024. https://www.ophthalmologytimes.com/view/stephen-nedoroscik-brings-awareness-to-strabismus-coloboma-at-the-2024-olympic-games

4. 20 Celebrities With Eye Conditions. American Academy of Ophthalmology. Published March 17, 2020. Accessed November 13, 2024. https://www.aao.org/eye-health/tips-prevention/20-celebrities-with-eye-conditions

5. Pallavi. 10 Celebrities you didn’t know have/had eye diseases and disorders. Specscart.co.uk. Published January 9, 2023. Accessed November 13, 2024. https://specscart.co.uk/blog/celebrities-eye-diseases