Adult Amblyopia and Strabismus Associated With Higher-Order Processing Deficits

Adults with amblyopia or strabismus may experience lingering cognitive and functional challenges that extend beyond reduced visual acuity. Photo: Christopher L. Suhr, OD. Click image to enlarge. A new study demonstrates that adults with amblyopia and/or strabismus face significant challenges in higher-order visual processing and executive function. These visuo-cognitive limitations were also tied to poorer performance on functional tasks and lower vision-related quality of life (VRQOL). These findings, recently published in Investigative Ophthalmology & Visual Science, underscore the long-term effects of abnormal visual development and the importance of targeted interventions. Researchers evaluated 114 adults, including individuals with amblyopia alone (n=23), amblyopia with strabismus (n=52), strabismus alone (n=20) and healthy controls (n=19). In addition to visual acuity testing and calculation of a binocular function score, participants completed three visuo-cognitive assessments: the Useful Field of View (UFOV), Trail Making Test (TMT) and Stroop Color and Word Test (SCWT).Significant group differences were found across all visuo-cognitive measures. Adults with amblyopia and/or strabismus showed slower completion times on UFOV, TMT and SCWT than healthy controls, with particularly marked deficits in divided attention, visual search and cognitive flexibility. Performance on the three tests was strongly correlated.In regression analyses, SCWT performance significantly predicted fine motor skills and reading speed, accounting for 42% and 31% of the variance, respectively. VRQOL results further highlighted the broad impact of these conditions. Psychosocial scores were strongly affected by the presence of strabismus. Additionally, the study authors reported that functional impact scores were associated with binocular function score and UFOV performance.“This study provides critical evidence of the broader impacts of amblyopia and strabismus on cognitive function and quality of life in adults, emphasizing deficits in visual attention, executive function and functional performance,” the research team wrote in their Investigative Ophthalmology & Visual Science paper. “The persistence of these deficits beyond the critical period of visual development suggests long-term neurocognitive effects,” they concluded, while noting that  future research should “explore neural substrates through imaging studies, assess longitudinal changes in these deficits and evaluate interventions targeting both visual and cognitive impairments to improve outcomes for affected individuals.”Click here for the journal source. Rakshit A, Schmid KL, Majhi D, et al. Visuo-Cognitive Executive Functions in Amblyopia and Strabismus: Associations With Function and Quality of Life. Invest Ophthalmol Vis Sci. 2025;66(14):48. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.