{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:44:56Z","timestamp":1791261896680,"version":"4.1.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2016,10,12]],"date-time":"2016-10-12T00:00:00Z","timestamp":1476230400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2016,10,12]],"date-time":"2016-10-12T00:00:00Z","timestamp":1476230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This systematic review and meta-analysis is to evaluate the risk of development of concomitant strabismus due to refractive errors. Eligible studies published from 1946 to April 1, 2016 were identified from MEDLINE and EMBASE that evaluated any kinds of refractive errors (myopia, hyperopia, astigmatism and anisometropia) as an independent factor for concomitant exotropia and concomitant esotropia. Totally 5065 published records were retrieved for screening, 157 of them eligible for detailed evaluation. Finally 7 population-based studies involving 23,541 study subjects met our criteria for meta-analysis. The combined OR showed that myopia was a risk factor for exotropia (OR: 5.23, P\u2009=\u20090.0001). We found hyperopia had a dose-related effect for esotropia (OR for a spherical equivalent [SE] of 2\u20133 diopters [D]: 10.16, P\u2009=\u20090.01; OR for an SE of 3-4D: 17.83, P\u2009&lt;\u20090.0001; OR for an SE of 4-5D: 41.01, P\u2009&lt;\u20090.0001; OR for an SE of \u22655D: 162.68, P\u2009&lt;\u20090.0001). Sensitivity analysis indicated our results were robust. Results of this study confirmed myopia as a risk for concomitant exotropia and identified a dose-related effect for hyperopia as a risk of concomitant esotropia.<\/jats:p>","DOI":"10.1038\/srep35177","type":"journal-article","created":{"date-parts":[[2016,10,12]],"date-time":"2016-10-12T09:16:43Z","timestamp":1476263803000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Refractive Errors and Concomitant Strabismus: A Systematic Review and Meta-analysis"],"prefix":"10.1038","volume":"6","author":[{"given":"Shu Min","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Y. T.","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Bin Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi Song","family":"Rong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry H. W.","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winnie W. Y.","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson W. K.","family":"Yip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li Jia","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon T. C.","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C. S.","family":"Yam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2016,10,12]]},"reference":[{"key":"BFsrep35177_CR1","doi-asserted-by":"publisher","first-page":"197","DOI":"10.3109\/09286586.2014.904371","volume":"21","author":"J Fu","year":"2014","unstructured":"Fu, J. et al. Prevalence of amblyopia and strabismus in a population of 7th-grade junior high school students in Central China: the Anyang Childhood Eye Study (ACES). Ophthalmic Epidemiology 21, 197\u2013203 (2014).","journal-title":"Ophthalmic Epidemiology"},{"key":"BFsrep35177_CR2","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1016\/j.ophtha.2007.08.001","volume":"115","author":"M-ePEDS Group","year":"2008","unstructured":"Group, M.-e. P. E. D. S. Prevalence of amblyopia and strabismus in African American and Hispanic children ages 6 to 72 months: the Multi-ethnic Pediatric Eye Disease Study. Ophthalmology 115, 1229\u20131236. e1221 (2008).","journal-title":"Ophthalmology"},{"key":"BFsrep35177_CR3","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.ophtha.2008.09.028","volume":"116","author":"C Samarawickrama","year":"2009","unstructured":"Samarawickrama, C., Fotedar, R., Mitchell, P. & Rose, K. Refractive error, strabismus, and amblyopia. Ophthalmology 116, 364\u2013365, author reply 365, doi: 10.1016\/j.ophtha.2008.09.028 (2009).","journal-title":"Ophthalmology"},{"key":"BFsrep35177_CR4","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1136\/bjophthalmol-2015-306999","volume":"100","author":"X Chen","year":"2016","unstructured":"Chen, X. et al. Prevalence of amblyopia and strabismus in Eastern China: results from screening of preschool children aged 36-72 months. Br J Ophthalmol 100, 515\u2013519, doi: 10.1136\/bjophthalmol-2015-306999 (2016).","journal-title":"Br J Ophthalmol"},{"key":"BFsrep35177_CR5","doi-asserted-by":"publisher","first-page":"482093","DOI":"10.1155\/2014\/482093","volume":"2014","author":"JC Yam","year":"2014","unstructured":"Yam, J. C. et al. Predictive factors affecting the short term and long term exodrift in patients with intermittent exotropia after bilateral rectus muscle recession and its effect on surgical outcome. Biomed Res Int 2014, 482093, doi: 10.1155\/2014\/482093 (2014).","journal-title":"Biomed Res Int"},{"key":"BFsrep35177_CR6","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.jaapos.2012.01.005","volume":"16","author":"JC Yam","year":"2012","unstructured":"Yam, J. C. et al. Long-term ocular alignment after bilateral lateral rectus recession in children with infantile and intermittent exotropia. J AAPOS 16, 274\u2013279, doi: 10.1016\/j.jaapos.2012.01.005 (2012).","journal-title":"J AAPOS"},{"key":"BFsrep35177_CR7","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.jaapos.2009.02.010","volume":"13","author":"Y Bez","year":"2009","unstructured":"Bez, Y. et al. Adult strabismus and social phobia: a case-controlled study. J AAPOS 13, 249\u2013252, doi: 10.1016\/j.jaapos.2009.02.010 (2009).","journal-title":"J AAPOS"},{"key":"BFsrep35177_CR8","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/S1091-8531(99)70004-2","volume":"3","author":"SE Olitsky","year":"1999","unstructured":"Olitsky, S. E. et al. The negative psychosocial impact of strabismus in adults. J AAPOS 3, 209\u2013211 (1999).","journal-title":"J AAPOS"},{"key":"BFsrep35177_CR9","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1016\/j.ajo.2014.01.012","volume":"157","author":"S Lin","year":"2014","unstructured":"Lin, S. et al. Alcohol use and positive screening results for depression and anxiety are highly prevalent among Chinese children with strabismus. Am J Ophthalmol 157, 894\u2013900 e891, doi: 10.1016\/j.ajo.2014.01.012 (2014).","journal-title":"Am J Ophthalmol"},{"key":"BFsrep35177_CR10","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/S0161-6420(99)00035-4","volume":"107","author":"DK Coats","year":"2000","unstructured":"Coats, D. K., Paysse, E. A., Towler, A. J. & Dipboye, R. L. Impact of large angle horizontal strabismus on ability to obtain employment. Ophthalmology 107, 402\u2013405 (2000).","journal-title":"Ophthalmology"},{"key":"BFsrep35177_CR11","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1016\/j.ajo.2006.06.053","volume":"142","author":"D Robaei","year":"2006","unstructured":"Robaei, D., Kifley, A. & Mitchell, P. Factors associated with a previous diagnosis of strabismus in a population-based sample of 12-year-old Australian children. American Journal of Ophthalmology 142, 1085\u20131088 (2006).","journal-title":"American Journal of Ophthalmology"},{"key":"BFsrep35177_CR12","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1016\/j.ophtha.2011.06.032","volume":"118","author":"SA Cotter","year":"2011","unstructured":"Cotter, S. A. et al. Risk factors associated with childhood strabismus: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology 118, 2251\u20132261 (2011).","journal-title":"Ophthalmology"},{"key":"BFsrep35177_CR13","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1016\/j.ophtha.2013.03.001","volume":"120","author":"R McKean-Cowdin","year":"2013","unstructured":"McKean-Cowdin, R. et al. Prevalence of amblyopia or strabismus in asian and non-Hispanic white preschool children: multi-ethnic pediatric eye disease study. Ophthalmology 120, 2117\u20132124, doi: 10.1016\/j.ophtha.2013.03.001 (2013).","journal-title":"Ophthalmology"},{"key":"BFsrep35177_CR14","first-page":"2486","volume":"41","author":"TY Wong","year":"2000","unstructured":"Wong, T. Y. et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Investigative ophthalmology & visual science 41, 2486\u20132494 (2000).","journal-title":"Investigative ophthalmology & visual science"},{"key":"BFsrep35177_CR15","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1001\/archopht.122.4.495","volume":"122","author":"EDPR Group","year":"2004","unstructured":"Group, E. D. P. R. The prevalence of refractive errors among adults in the United States, Western Europe, and Australia. Archives of ophthalmology 122, 495 (2004).","journal-title":"Archives of ophthalmology"},{"key":"BFsrep35177_CR16","doi-asserted-by":"publisher","first-page":"6235","DOI":"10.1167\/iovs.14-15046","volume":"55","author":"SS Rong","year":"2014","unstructured":"Rong, S. S., Peng, Y., Liang, Y. B., Cao, D. & Jhanji, V. Does cigarette smoking alter the risk of pterygium? A systematic review and meta-analysis. Invest Ophthalmol Vis Sci 55, 6235\u20136243, doi: 10.1167\/iovs.14-15046 (2014).","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"BFsrep35177_CR17","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1136\/bjo.2005.083154","volume":"90","author":"SC Huynh","year":"2006","unstructured":"Huynh, S. C. et al. Prevalence and associations of anisometropia and aniso-astigmatism in a population based sample of 6 year old children. British Journal of Ophthalmology 90, 597\u2013601 (2006).","journal-title":"British Journal of Ophthalmology"},{"key":"BFsrep35177_CR18","doi-asserted-by":"crossref","unstructured":"Zhu, H. et al. Association between childhood strabismus and refractive error in Chinese preschool children. PLoS ONE 10 (3) (no pagination) (2015).","DOI":"10.1371\/journal.pone.0120720"},{"key":"BFsrep35177_CR19","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","volume":"21","author":"JP Higgins","year":"2002","unstructured":"Higgins, J. P. & Thompson, S. G. Quantifying heterogeneity in a meta-analysis. Statistics in medicine 21, 1539\u20131558, doi: 10.1002\/sim.1186 (2002).","journal-title":"Statistics in medicine"},{"key":"BFsrep35177_CR20","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.cct.2015.09.002","volume":"45","author":"R DerSimonian","year":"2015","unstructured":"DerSimonian, R. & Laird, N. Meta-analysis in clinical trials revisited. Contemporary clinical trials 45, 139\u2013145, doi: 10.1016\/j.cct.2015.09.002 (2015).","journal-title":"Contemporary clinical trials"},{"key":"BFsrep35177_CR21","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1146\/annurev.pu.09.050188.001011","volume":"9","author":"SJ Kuritz","year":"1988","unstructured":"Kuritz, S. J., Landis, J. R. & Koch, G. G. A general overview of Mantel-Haenszel methods: applications and recent developments. Annu Rev Public Health 9, 123\u2013160, doi: 10.1146\/annurev.pu.09.050188.001011 (1988).","journal-title":"Annu Rev Public Health"},{"key":"BFsrep35177_CR22","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1016\/S0895-4356(00)00242-0","volume":"53","author":"JA Sterne","year":"2000","unstructured":"Sterne, J. A., Gavaghan, D. & Egger, M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. Journal of clinical epidemiology 53, 1119\u20131129 (2000).","journal-title":"Journal of clinical epidemiology"},{"key":"BFsrep35177_CR23","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1016\/j.ophtha.2006.02.019","volume":"113","author":"D Robaei","year":"2006","unstructured":"Robaei, D. et al. Factors Associated with Childhood Strabismus. Findings from a Population-Based Study. Ophthalmology 113, 1146\u20131153 (2006).","journal-title":"Ophthalmology"},{"key":"BFsrep35177_CR24","doi-asserted-by":"publisher","first-page":"138","DOI":"10.3109\/09286586.2013.767354","volume":"20","author":"A Chia","year":"2013","unstructured":"Chia, A. et al. Risk factors for strabismus and amblyopia in young Singapore Chinese children. Ophthalmic Epidemiology 20, 138\u2013147 (2013).","journal-title":"Ophthalmic Epidemiology"},{"key":"BFsrep35177_CR25","doi-asserted-by":"publisher","first-page":"2109","DOI":"10.1016\/j.ophtha.2013.06.039","volume":"120","author":"G Wen","year":"2013","unstructured":"Wen, G. et al. Prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white and Asian children: multi-ethnic pediatric eye disease study. Ophthalmology 120, 2109\u20132116, doi: 10.1016\/j.ophtha.2013.06.039 (2013).","journal-title":"Ophthalmology"},{"key":"BFsrep35177_CR26","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/s10384-004-0175-7","volume":"49","author":"C Nakatsuka","year":"2005","unstructured":"Nakatsuka, C., Hasebe, S., Nonaka, F. & Ohtsuki, H. Accommodative lag under habitual seeing conditions: comparison between myopic and emmetropic children. Jpn J Ophthalmol 49, 189\u2013194, doi: 10.1007\/s10384-004-0175-7 (2005).","journal-title":"Jpn J Ophthalmol"},{"key":"BFsrep35177_CR27","first-page":"489","volume":"50","author":"F Xie","year":"2014","unstructured":"Xie, F. et al. [Clinical investigation on AC\/A ratio in intermittent exotropia coexisting with ametropia]. Zhonghua Yan Ke Za Zhi 50, 489\u2013493 (2014).","journal-title":"Zhonghua Yan Ke Za Zhi"},{"key":"BFsrep35177_CR28","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1016\/S0002-9394(00)00760-1","volume":"130","author":"CO Mutti","year":"2000","unstructured":"Mutti, C. O., Jones, L. A., Moeschberger, M. L. & Zadnik, K. AC\/A ratio, age, and refractive error in children. Am J Ophthalmol 130, 690 (2000).","journal-title":"Am J Ophthalmol"},{"key":"BFsrep35177_CR29","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1097\/01.OPX.0000159363.07082.7D","volume":"82","author":"J Gwiazda","year":"2005","unstructured":"Gwiazda, J., Thorn, F. & Held, R. Accommodation, accommodative convergence, and response AC\/A ratios before and at the onset of myopia in children. Optom Vis Sci 82, 273\u2013278 (2005).","journal-title":"Optom Vis Sci"},{"key":"BFsrep35177_CR30","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1001\/archopht.124.6.844","volume":"124","author":"R Agrawal","year":"2006","unstructured":"Agrawal, R., Conner, I. P., Odom, J., Schwartz, T. L. & Mendola, J. D. Relating binocular and monocular vision in strabismic and anisometropic amblyopia. Archives of ophthalmology 124, 844\u2013850 (2006).","journal-title":"Archives of ophthalmology"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/srep35177.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep35177","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep35177.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T02:51:26Z","timestamp":1672887086000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/srep35177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,12]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,12,16]]}},"alternative-id":["BFsrep35177"],"URL":"https:\/\/doi.org\/10.1038\/srep35177","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,12]]},"assertion":[{"value":"2 June 2016","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2016","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2016","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"35177"}}