{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:44:50Z","timestamp":1760240690470,"version":"build-2065373602"},"reference-count":43,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T00:00:00Z","timestamp":1566345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81673197"],"award-info":[{"award-number":["81673197"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The effect of exotropia on the intelligence of children is unknown. This study aimed to assess the intelligence in children with exotropia and investigate the influence of the main clinical indexes of strabismus on intelligence. Eighty-four participants aged 8\u201312 years were enrolled, including 37 patients with exotropia (exotropia group) and 47 normal individuals (normal group). Intelligence was assessed by the Wechsler Intelligence Scale for Children\u2014Fourth Edition (WISC-IV), including the Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), Processing Speed Index (PSI), and Full-Scale Intelligence Quotient (FSIQ). The exotropia group had a significantly lower PRI score but a higher PSI score than the normal group. However, there was no significant difference in the WMI, VCI, and FSIQ between groups. Multiple linear regression showed that PRI\u2013WMI and PRI\u2013PSI differences were significantly lower in the exotropia group. Inter-subscale correlations analysis showed that the pattern of intelligence structure was different between groups. The type of exotropia, angle of deviation, duration of symptoms, and stereoacuity had no effect on the intelligence of children with exotropia. Children with exotropia had a relatively worse performance in the perceptual reasoning skill but a better processing speed and a different pattern of intelligence structure.<\/jats:p>","DOI":"10.3390\/ijerph16173008","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T11:19:06Z","timestamp":1566386346000},"page":"3008","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Characterization of Intelligence in Children with Exotropia"],"prefix":"10.3390","volume":"16","author":[{"given":"Tao","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7085-4667","authenticated-orcid":false,"given":"Zhonghao","family":"Wang","sequence":"additional","affiliation":[{"name":"State key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Shen","sequence":"additional","affiliation":[{"name":"State key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianhua","family":"Yan","sequence":"additional","affiliation":[{"name":"State key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuanbo","family":"Xie","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 East Dongfeng Road, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuhong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Green-Simms, A.E., and Mohney, B.G. (2010). Epidemiology of Pediatric Strabismus, Springer. [2nd ed.].","DOI":"10.1007\/978-3-540-85851-5_1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1080\/09273972.2016.1242639","article-title":"Prevalence and Risk Factors of Strabismus in a UK Multi-ethnic Birth Cohort","volume":"24","author":"Bruce","year":"2016","journal-title":"Strabismus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1080\/09273972.2019.1604773","article-title":"Global and regional prevalence of strabismus: A comprehensive systematic review and meta\u2212analysis","volume":"27","author":"Hashemi","year":"2019","journal-title":"Strabismus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/09273972.2014.999795","article-title":"The prevalence of strabismus in 7-year-old schoolchildren in Iran","volume":"23","author":"Hashemi","year":"2015","journal-title":"Strabismus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1016\/j.ophtha.2013.03.001","article-title":"Prevalence of amblyopia or strabismus in asian and non-Hispanic white preschool children: Multi-ethnic pediatric eye disease study","volume":"120","author":"Cotter","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1001\/jamaophthalmol.2017.3158","article-title":"Strabismus Incidence in a Danish Population-Based Cohort of Children","volume":"135","author":"Boyd","year":"2017","journal-title":"JAMA Ophthalmol."},{"key":"ref_7","first-page":"1489537","article-title":"Exotropia Is the Main Pattern of Childhood Strabismus Surgery in the South of China: A Six-Year Clinical Review","volume":"8","author":"Yu","year":"2016","journal-title":"J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e025441","DOI":"10.1136\/bmjopen-2018-025441","article-title":"Prevalence of amblyopia and strabismus in Hani school children in rural southwest China: A cross-sectional study","volume":"9","author":"Zhu","year":"2019","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"37","DOI":"10.2188\/jea.JE20110063","article-title":"Prevalence of Eye Diseases and Causes of Visual Impairment in School-Aged Children in Western China","volume":"22","author":"Pi","year":"2012","journal-title":"J. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1136\/bjophthalmol-2015-306999","article-title":"Prevalence of amblyopia and strabismus in Eastern China: Results from screening of preschool children aged 36\u221272 months","volume":"100","author":"Chen","year":"2016","journal-title":"Br. J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.cognition.2019.03.014","article-title":"Visual form perception is fundamental for both reading comprehension and arithmetic computation","volume":"189","author":"Cui","year":"2019","journal-title":"Cognition"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1080\/00797308.1970.11823279","article-title":"A study of the psychological effects of strabismus","volume":"25","author":"Lipton","year":"1970","journal-title":"Psychoanal. Study Child"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3109\/00048678409161038","article-title":"Psychological and educational correlates of strabismus in school children","volume":"18","author":"Tonge","year":"1984","journal-title":"Aust. N. Z. J. Psychiatry."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1080\/09273970500455436","article-title":"The relationship between convergence insufficiency and ADHD","volume":"13","author":"Granet","year":"2005","journal-title":"Strabismus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"806","DOI":"10.3349\/ymj.2012.53.4.806","article-title":"Parent-reported symptoms of attention deficit hyperactivity disorder in children with intermittent exotropia before and after strabismus surgery","volume":"53","author":"Chung","year":"2012","journal-title":"Yonsei. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jaapos.2017.04.001","article-title":"Strabismus and mental disorders among Israeli adolescents","volume":"21","author":"Merdler","year":"2017","journal-title":"J. AAPOS"},{"key":"ref_17","first-page":"139","article-title":"Intelligence Quotient (IQ) in Congenital Strabismus","volume":"8","author":"Bagheri","year":"2013","journal-title":"J. Ophthalmic. Vis. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5539\/gjhs.v8n3p26","article-title":"Comparing Intelligence Quotient (IQ)among 3 to 7-year-old strabismic and nonstrabismic children in an Iranian population","volume":"8","author":"Ghaderpanah","year":"2015","journal-title":"Glob. J. Health Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1038\/eye.2014.279","article-title":"A Stereo vision and strabismus","volume":"29","author":"Read","year":"2015","journal-title":"Eye"},{"key":"ref_20","first-page":"668","article-title":"Altered intrinsic functional connectivity of the primary visual cortex in youth patients with comitant exotropia: A resting state fMRI study","volume":"11","author":"Zhu","year":"2018","journal-title":"Int. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1016\/j.ridd.2011.03.018","article-title":"The influence of manifest strabismus and stereoscopic vision on non-verbal abilities of visually impaired children","volume":"32","author":"Jablan","year":"2011","journal-title":"Res. Dev. Disabil."},{"key":"ref_22","unstructured":"Flanagan, D.P., and Kaufman, A.S. (2009). Essentials of WISC-IV Assessment, John Wiley & Sons Inc.. [2nd ed.]."},{"key":"ref_23","unstructured":"(2015). The strabismus and pediatric ophthalmology group OB of CMA Chinese expert consensus on strabismus classification. Chin. J. Ophthalmol., 51, 408\u2013410."},{"key":"ref_24","first-page":"1177","article-title":"The revision of WISC-IV Chinese version","volume":"32","author":"Zhang","year":"2009","journal-title":"Psychol. Sci."},{"key":"ref_25","first-page":"692","article-title":"Reliability and construct validity of the Chinese version of the Wechsler Adult Intelligence Scale\u2212Fourth Edition","volume":"27","author":"Wang","year":"2013","journal-title":"Chinese Ment. Heal. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.braindev.2004.02.002","article-title":"Visual-perceptual impairment in children with periventricular leukomalacia","volume":"26","author":"Fazzi","year":"2004","journal-title":"Brain Dev."},{"key":"ref_27","first-page":"3857","article-title":"Effects of strabismic amblyopia on visuomotor behavior: Part II. Visually guided reaching","volume":"99","author":"Dadeya","year":"2014","journal-title":"Vision Res."},{"key":"ref_28","first-page":"232","article-title":"Comparing visual perceptual skills among 8 to 10-year-old strabismal\/nonstrabismal cerebral palsy children","volume":"15","author":"Sayyadi","year":"2011","journal-title":"Feyz. J. Kashan. Univ. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"17108","DOI":"10.1523\/JNEUROSCI.1831-13.2013","article-title":"Strabismus Disrupts Binocular Synaptic Integration in Primary Visual Cortex","volume":"33","author":"Scholl","year":"2013","journal-title":"J. Neurosci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10286","DOI":"10.1523\/JNEUROSCI.1435-12.2012","article-title":"Perception via the deviated eye in strabismus","volume":"32","author":"Economides","year":"2012","journal-title":"J. Neurosci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1080\/13803390600770793","article-title":"The impact of blurred vision on cognitive assessment","volume":"29","author":"Bertone","year":"2007","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref_32","first-page":"1151","article-title":"Clinical study of binocular vision in intermittent and constant exotropia","volume":"30","author":"Li","year":"2010","journal-title":"Recent Adv. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s41235-017-0062-7","article-title":"Magnitude, precision, and realism of depth perception in stereoscopic vision","volume":"2","author":"Hibbard","year":"2017","journal-title":"Cogn. Res. Princ. Implic."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1038\/eye.1996.54","article-title":"The neural basis of suppression and amblyopia in strabismus","volume":"10","author":"Sengpiel","year":"1996","journal-title":"Eye"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2352","DOI":"10.1167\/iovs.10-6144","article-title":"Visual suppression in intermittent exotropia during binocular alignment","volume":"52","author":"Manjunath","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1067\/mpa.2002.122059","article-title":"Surgical results in large-angle exotropia","volume":"6","author":"Gunton","year":"2002","journal-title":"J. AAPOS"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0002-9394(00)00623-1","article-title":"Timely surgery in intermittent and constant exotropia for superior sensory outcome","volume":"131","author":"Abroms","year":"2001","journal-title":"Am. J. Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1136\/bjophthalmol-2014-306545","article-title":"Childhood intermittent exotropia from a different angle: Does severity affect quality of life?","volume":"99","author":"Lim","year":"2015","journal-title":"Br. J. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jaapos.2017.04.005","article-title":"Relationship among clinical factors in childhood intermittent exotropia","volume":"21","author":"Superstein","year":"2017","journal-title":"J. AAPOS"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1136\/bjophthalmol-2014-304888","article-title":"Effects of corrective surgery on social phobia, psychological distress, disease\u2212related disability and quality of life in adult strabismus patients","volume":"98","author":"Alpak","year":"2014","journal-title":"Br. J. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/ICU.0000000000000087","article-title":"Impact of strabismus surgery on health-related quality of life in adults","volume":"25","author":"Gunton","year":"2014","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_42","first-page":"529","article-title":"Relationship between Binocular Summation and Stereoacuity after Strabismus Surgery","volume":"16","author":"Kattan","year":"2016","journal-title":"Am. J. Ophthalmol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1001\/jamaophthalmol.2014.5265","article-title":"Improvement in binocular summation after strabismus surgery","volume":"133","author":"Pineles","year":"2015","journal-title":"JAMA Ophthalmol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/17\/3008\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:12:37Z","timestamp":1760188357000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/17\/3008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,21]]},"references-count":43,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2019,9]]}},"alternative-id":["ijerph16173008"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16173008","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2019,8,21]]}}}