Presenting features and early management of childhood intermittent exotropia in the UK: inception cohort study

Buck, Deborah; Powell, Christine; Cumberland, Phillippa; Davis, Hilton; Dawson, Emma; Rahi, Jugnoo S; Sloper, John J.; Taylor, Robert H.; Tiffin, Peter; Clarke, Michael

doi:10.1136/bjo.2008.152975

Cited by 40 publications

(34 citation statements)

References 21 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The IOXT study16 17 recruited a total of 460 patients from 26 paediatric eye clinics across the UK between May 2005 and December 2006. Children under 12 years, diagnosed with X(T) within the prior 12 months and previously untreated, were eligible.…”

Section: Methodsmentioning

confidence: 99%

“…The NCS combines an estimate of observed frequency of exotropia by parents (home control) with assessment of the child's ability to realign the eye following a cover test to induce misalignment (clinic control): possible total NCS scores range from 0–9 (0–3 for home, 0–6 for clinic control) with higher scores indicative of poorer control. Near stereoacuity data are reported for those aged ≥4 years at their preoperative assessment because younger children were unable to consistently complete testing 16. Distance stereoacuity testing was possible in a limited number of centres and is therefore not reported.…”

Section: Methodsmentioning

confidence: 99%

“…The Improving Outcomes in Intermittent Exotropia (IOXT) study16 17 is an observational study which recruited 460 children from an inception cohort: 87 underwent surgery. This paper reports the surgical management, preoperative and surgical characteristics, and postoperative outcomes for these 87 children, and explores whether any characteristics, particularly initial postoperative alignment, were associated with outcome.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study

et al. 2012

View full text Add to dashboard Cite

Whilst excellent motor/sensory outcome was achieved in one-third and satisfactory control in two-thirds of patients, the 37% poor outcome and 15% persistent over-correction rate is of concern. Surgical dose was similar in those under- and over-corrected, suggesting that over-corrections cannot be avoided merely by getting the dosage right: a randomised controlled trial (RCT) would shed light on this issue. Initial over-correction did not improve the chance of a good outcome, supporting the growing literature on this topic and further highlighting the need for randomised controlled trials of X(T) surgery.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Patching either the preferred eye or alternate patching is one of several prescribed non-surgical treatments for children affected by IXT. 6–9 Often prescribed as a method for delaying surgery, 10 the reported possible benefits 11–19 of patching include elimination of suppression, decreasing the frequency or magnitude of the deviation, and/or changing the character of the deviation (e.g., from constant exotropia to IXT or IXT to exophoria).…”

mentioning

confidence: 99%

A Randomized Trial Comparing Part-Time Patching with Observation for Children 3 to 10 Years of Age with Intermittent Exotropia

et al. 2014

View full text Add to dashboard Cite

Objective To determine the effectiveness of prescribed part-time patching for treatment of intermittent exotropia in children Design Multicenter, randomized clinical trial Participants Three hundred fifty-eight children aged 3 to < 11 years old with previously untreated (except for refractive correction) intermittent exotropia (IXT) and near stereoacuity of 400 arcsec or better were enrolled. Intermittent exotropia met the following criteria: 1) constant or intermittent exotropia at distance and either intermittent exotropia or exophoria at near; 2) exodeviation (tropia or phoria) of at least 15 prism diopters (Δ) at distance or near by prism and alternate cover test (PACT); and 3) exodeviation of at least 10Δ at distance by PACT. Methods Participants were randomly assigned to either observation (no treatment for 6 months) or patching for 3 hours per day for 5 months, with a 1-month washout period of no patching before the 6-month primary outcome exam. Main Outcome Measure The primary outcome was deterioration at either the 3-month or the 6-month follow-up visit, defined as: 1) constant exotropia measuring at least 10Δ at distance and near by simultaneous prism and cover test, and/or 2) near stereoacuity decreased by at least 2 octaves from baseline, both assessed by a masked examiner and confirmed by a retest. Participants who were prescribed any non-randomized treatment without first meeting either deterioration criteria were also counted as having deteriorated. Results Of the 324 (91%) participants completing the 6-month primary outcome exam, deterioration occurred in 10 (6.1%) of the 165 participants in the observation group (3 of these 10 started treatment without meeting deterioration criteria) and in 1 (0.6%) of the 159 participants in the part-time patching group (difference = 5.4%, lower limit of one-sided exact 95% confidence interval = 2.0%; p value from one-sided hypothesis test = 0.004). Conclusion Deterioration of previously untreated childhood IXT over a 6-month period is uncommon with or without patching treatment. Although there is a slightly lower deterioration rate with patching, both management approaches are reasonable for treating 3 to 10 year olds with IXT.

show abstract

“…Although a common condition, the best treatment and optimal timing for this disorder remain unclear, 6, 7 particularly for young children who are often unable to cooperate for a sensorimotor eye examination or for some non-surgical treatments such as orthoptic exercises. Given these challenges, part-time patching is commonly prescribed in young children as a temporizing measure 8-11 to delay potential surgery or until other forms of non-surgical treatment become feasible. The reported potential benefits of patching include the preservation of binocularity and a reduction in the frequency and/or magnitude of the exodeviation.…”

mentioning

confidence: 99%

A Randomized Trial Comparing Part-time Patching with Observation for Intermittent Exotropia in Children 12 to 35 Months of Age

et al. 2015

View full text Add to dashboard Cite

Objective To determine the effectiveness of part-time patching for treating intermittent exotropia (IXT) in young children Design Multicenter, randomized clinical trial Participants Two hundred one children 12 to 35-months-old with untreated IXT meeting the following criteria: 1) IXT at distance OR constant exotropia at distance and either IXT or exophoria at near; 2) ≥15 prism diopter (Δ) exodeviation at distance or near by prism and alternate cover test (PACT) but at least 10Δ exodeviation at distance by PACT. Methods Participants were randomly assigned to either observation (no treatment for 6 months) or patching prescribed for 3 hours daily for 5 months, followed by 1 month of no patching. Main Outcome Measure The primary outcome was deterioration, defined as constant exotropia measuring at least 10Δ at distance and near or receipt of non-protocol treatment for IXT. Results Of the 177 participants (88%) completing the 6-month primary outcome examination, deterioration occurred in 4.6% (4 of 87) of the participants in the observation group and in 2.2% (2 of 90) of the participants in the patching group (difference = 2.4%; P = 0.27, 95% confidence interval (CI) = -3.8% to +9.4%). Motor deterioration occurred in 2.3% (2 of 87) of the observation group and in 2.2% (2 of 90) of the patching group (difference = 0.08%, P = 0.55, 95% CI = -5.8% to +6.1%). For the observation and patching groups respectively, 6-month mean PACT measurements were 27.9Δ versus 24.9Δ at distance (P = 0.02) and 19.3Δ versus 17.0Δ at near (P = 0.10); 6-month mean exotropia control scores were 2.8 vs. 2.3 points at distance (P = 0.02), and 1.4 vs. 1.1 points at near (P = 0.26). Conclusion Among children 12 to 35 months of age with previously untreated IXT, deterioration over 6 months was uncommon, with or without patching treatment. There was insufficient evidence to recommend part-time patching for the treatment of IXT in children in this age group.

show abstract

Presenting features and early management of childhood intermittent exotropia in the UK: inception cohort study

Abstract: X(T) can be a presenting sign of reduced visual acuity. Most children with well controlled X(T) receive no treatment within 12 months following presentation.

Cited by 40 publications

References 21 publications

Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study

Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study

A Randomized Trial Comparing Part-Time Patching with Observation for Children 3 to 10 Years of Age with Intermittent Exotropia

A Randomized Trial Comparing Part-time Patching with Observation for Intermittent Exotropia in Children 12 to 35 Months of Age

Contact Info

Product

Resources

About