The Newcastle Control Score: a new method of grading the severity of intermittent distance exotropia

Haggerty, Helen R.; Richardson, Sarah; Hrisos, Susan; Strong, Nicholas; Clarke, Michael

doi:10.1136/bjo.2003.027615

Cited by 107 publications

(77 citation statements)

References 9 publications

(6 reference statements)

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“…Most other methods of rating control in IXT, whether semi-quantitative 11,13 or quantitative, 9 use broader, less strictly-defined categories with perhaps less potential for observer variability. Nevertheless, our observation of a change from spontaneous tropia to phoria in several patients would have also constituted a 'change' in these alternative control scales.…”

Section: Discussionmentioning

confidence: 99%

“…Control scales [9][10][11][12][13] allow quantification of control, but it remains unclear whether these measures reliably represent severity. The purpose of this study was to assess changes in control occurring over the course of a day and a period of several minutes using a previously described 6-point control scale 10 in patients with intermittent exotropia.…”

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confidence: 99%

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Variability of Control in Intermittent Exotropia

et al. 2008

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Purpose-Assessing control is thought to be important in the management of intermittent exotropia (IXT), including the decision to perform surgery. The purpose of this study was to assess the presence and degree of any change in control occurring over the course of 1 day using a previously described 6-point clinic control scale, and to evaluate inter-observer and minute-to-minute variability. Design-Prospective case series. Participants-25 patients with intermittent exotropia.Methods-Inter-observer agreement was determined in 17 patients by comparing control scores assessed simultaneously by 2 observers (kappa test). Minute-to-minute variability was observed in the same 17 patients by assessing control twice within 5 minutes. Variability over one day was assessed in 5 of these patients plus 8 additional patients (n=13) by comparing 3 or 4 assessments at least 2 hours apart.Main outcome measure-Control of IXT measured using a 6-point clinic control scale.Results-Inter-observer agreement was high (k=0.94 for distance and k=0.95 for near fixation). Disagreements were no more than one level on the control scale; therefore, for further analysis, change in control was defined as 2 or more levels. For minute-to-minute variability, 4 (24%) of the 17 patients tested twice within 5 minutes showed a change in control: 1 (6%) changed from tropia to phoria at distance, 3 (18%) from phoria to tropia at near. Of the 13 patients assessed over 1 day, 6 (46%) showed change in control, 2 at distance fixation only, 3 at near only and 1 at near and distance.Conclusions-Control of IXT can vary throughout the day, even within minutes, including from phoric to spontaneously tropic, and vice versa. The worst level of control was not always later in the day. This suggests that an isolated assessment of control may not categorize severity of IXT in an individual patient.Intermittent exotropia (IXT) is a common form of childhood strabismus 1, 2 characterized by intermittent divergent misalignment that is often greater at distance fixation. Severity and progression of IXT are currently assessed by determining angle of deviation, stereoacuity, ability to control the deviation and parental reports of frequency. 'Control' may be defined as an estimate of the proportion of time the deviation is manifest and the ease of re-establishing fusion after dissociation. Although the natural history and indications for surgical intervention are poorly defined, 3 it is commonly held that poor control of the exodeviation is a sign of deterioration. 4 On this basis, surgery has been recommended by some authors when the exotropia occurs more than 50% of waking hours or when there is a gradual loss of fusional control as evidenced by an increasing frequency of the exotropia. [4][5][6] Others have suggested that early surgery results in superior sensory outcomes 7, 8 but the timing of surgery for IXT has not been subjected to a randomized clinical trial and prior to such a trial, outcome measures such as control need to be rigorously studied.Until recen...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Variability of Control in Intermittent Exotropia

et al. 2008

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“…14 Patients with lateral gaze incomitance defined as reduction in the angle of exodeviation of 20% or more upon lateral gazing were excluded from the study. In addition, patients with constant exotropia, or intermittent exotropia of very poor control simulating constant exotropia (Newcastle control score ¼ 7) 18 were also excluded from the study.…”

Section: Initial Retrospective Partmentioning

confidence: 99%

Intermittent exotropia: relation between age and surgical outcome: a change-point analysis

Awadein

Eltanamly

ElShazly

2014

Eye

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Purpose To study the relationship between age and response to surgery in patients with intermittent exotropia and to identify change points in response to surgery. Methods A retrospective analysis was conducted on 311 patients with intermittent exotropia who had bilateral lateral rectus recession using standard tables with minimum follow-up of 6 months. Data were analyzed using the change-point analysis software to identify cutoff points. A prospective pilot study was then performed on 171 consecutive patients with intermittent exotropia with the same clinical characteristics, in whom amount of recession was modified according to the identified cutoff points. In angles with two change points, 1-mm recession was reduced from patients younger than the lower change point and 1.5-mm recession was added to those older than the upper change point. In angles with one change point, 1.5-mm recession was added to those older than the change point. Satisfactory alignment was defined as esophoria/tropia r5D to exophoria/tropia r8D. Results There was a negative correlation (Po0.01) between response to surgery and age at surgery for all angles. In younger patients (o7 years) in whom surgical dose was reduced, there was no significant change in success rate (77%), compared with those who had surgery using standard tables (75%). In older patients (412 years) in whom surgical dose was increased, there was a statistically significant increase in success rate (80% vs 41%). Conclusions Modifying the surgical dose according to age can improve the success in patients with intermittent exotropia.

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“…Such control has been graded in a variety of ways by previous investigators; some use a 3-point office-based scale (excellent or good, moderate or fair and poor), 7, 8 and others have suggested a scale that involves both parental report and in-office observation. 9 Assessing distance stereoacuity has been advocated as a measure of control in IXT, in contrast to near stereoacuity which is often preserved until late in the course of the condition. 7 Stathacopoulos et al7 described the association of poor distance stereoacuity with IXT, compared with normal controls.…”

Section: Introductionmentioning

confidence: 99%