Childhood Strabismus from A Different Perspective: Examining Its Association with Cognitive Development

Background: Previous studies have shown that abnormal visual input and processing possibly impact the cognition development in children. We aimed to investigate the relationship between abnormal visual function associated with strabismus and cognition development in children. Methods: Conducted at Zhongshan Ophthalmic Center, this cross-sectional case-control study involved 201 children aged 4-10 years, including 114 with strabismus and 87 matched controls, between January 2021 and December 2022. Cognitive functions were evaluated using the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV) and the Wechsler Preschool and Primary Scale of Intelligence—Fourth Edition (WPPSI-IVR), focusing on the global cognitive score (GCS), verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), and processing speed index (PSI). Results: Children with strabismus showed significantly lower scores in GCS (t=-8.31, p<0.001), VCI (t=-7.81, p<0.001), PRI (t=-6.18, p<0.001), WMI (t=-5.55, p<0.001), and PSI (t=-3.51, p=0.006) compared to controls. The type of strabismus (esotropia or exotropia, intermittent of constant tropia) did not show a significant association with cognitive performance (p>0.05). Spearman’s correlation and multivariate linear regression analyses identified that better fusion ability (p=0.01) and a shorter duration of strabismus (p=0.002) were associated with higher cognitive function. Conclusion: The findings reveal a significant decline in cognitive performance among children with strabismus compared to their non-strabismic peers, regardless of the type of strabismus. The duration of strabismus and impaired near fusion function are associated with cognitive development levels, highlighting the importance of early detection and potential interventions to support better cognitive outcomes.