Treatment Options in Intermittent Exotropia: A Critical Appraisal

Coffey, Bradley; Wick, Bruce; Cotter, Susan A.; Scharre, Janice Emigh; Horner, Douglas G.

doi:10.1097/00006324-199205000-00008

Cited by 53 publications

(37 citation statements)

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“…While surgery is often considered for treatment, many cases of IXT are treated using non-surgical interventions such as overminus lenses or occlusion. 5–8 Overminus lens therapy involves wearing full-time spectacles that have additional minus power over the cycloplegic refractive correction and is prescribed by some eye care providers to improve control and/or to reduce the angle of the exodeviation as a primary treatment or as a temporizing treatment in young children before surgery or orthoptic therapy is considered. 9 One proposed mechanism for improvement with overminus lens therapy is that stimulation of accommodative convergence either reduces the angle of exodeviation or triggers reflex convergence.…”

Section: Introductionmentioning

confidence: 99%

“…9 One proposed mechanism for improvement with overminus lens therapy is that stimulation of accommodative convergence either reduces the angle of exodeviation or triggers reflex convergence. 5, 10 An alternative hypothesis is that fusional convergence is exerted to control the exodeviation, inducing convergence accommodation and distance blur, and that overminus lenses may allow clear distance vision, facilitating fusion. 11 …”

Section: Introductionmentioning

confidence: 99%

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A Randomized Trial Evaluating Short-term Effectiveness of Overminus Lenses in Children 3 to 6 Years of Age with Intermittent Exotropia

et al. 2016

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Purpose To evaluate the short-term effectiveness of overminus spectacles in improving control of childhood intermittent exotropia (IXT) Design Randomized clinical trial Participants 58 children 3 to <7 years old with IXT. Eligibility criteria included a distance control score of 2 or worse (mean of 3 measures during a single examination) on a scale of 0 (exophoria) to 5 (constant exotropia), and spherical equivalent refractive error between −6.00 diopters (D) and +1.00D Intervention Children were randomly assigned to either overminus spectacles (−2.50D over cycloplegic refraction) or observation (non-overminus spectacles if needed, or no spectacles) for 8 weeks. Main Outcome Measures The primary outcome was distance control score for each child (mean of 3 measures during a single examination) assessed by masked examiner at 8 weeks. Outcome testing was conducted with children wearing their study spectacles, or plano spectacles for observation group children who did not need spectacles. The primary analysis compared mean 8-week distance control score between treatment groups using an analysis of covariance model which adjusted for baseline distance control, baseline near control, pre-study spectacle wear, and prior IXT treatment. Treatment side effects were evaluated using questionnaires completed by parents. Results At 8 weeks, mean distance control was better in the 27 children treated with overminus spectacles than in the 31 children who were observed without treatment (2.0 vs 2.8 points, adjusted difference = −0.75 points favoring the overminus group; two-sided 95% confidence interval = −1.42 to −0.07 points). Side effects of headaches, eyestrain, avoidance of near activities, and blur appeared similar between treatment groups. Conclusions In a pilot randomized clinical trial, overminus spectacles improved distance control at 8 weeks in children 3 to <7 years old with IXT. A larger and longer randomized trial is warranted to assess the effectiveness of overminus spectacles in treating IXT, particularly the effect on control after overminus treatment has been discontinued.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Randomized Trial Evaluating Short-term Effectiveness of Overminus Lenses in Children 3 to 6 Years of Age with Intermittent Exotropia

et al. 2016

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“…1 Nevertheless, there is no consensus regarding the optimum type of treatment and the optimum timing of treatment. [2][3][4] Current management options include watchful waiting, 5 part-time occlusion, 4,6-8 over-minus spectacles, [9][10][11][12] fusion exercises, 13 and strabismus surgery. [2][3][4] Much of the controversy is due to limited data on the natural history of intermittent XT and limited data on the long-term outcomes with each type of intervention.…”

Section: Introductionmentioning

confidence: 99%

Is intermittent exotropia a curable condition?

Holmes

Hatt

2014

Eye

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Surgical treatment of childhood intermittent exotropia (XT) is associated with high recurrence rates. In addition, the natural history of intermittent XT has not been rigorously studied and, anecdotally, some cases resolve without surgery. We compared long-term cure rates in children with surgically and nonsurgically managed intermittent XT. Children undergoing surgery for intermittent XT who had 5 years follow-up were retrospectively identified. A non-surgical cohort of comparable children was selected by matching each surgical patient for age at onset and age at the 5-year examination. Cure was defined as no manifest tropia on examination or by history, no new monofixation (stereoacuity subnormal for age), and no additional surgery. Each group had 33 children (total follow-up from presentation 7.2 ± 2.6 years in the surgical group vs 6.8 ± 2.3 years). There were no significant differences between groups for age at onset, age at presentation, or distance or near angle of deviation at presentation (all PZ0.4). The cure rate at 5 years was 30% in the surgical group and 12% in the non-surgical group (P ¼ 0.1; difference 18%, 95% CI À 1 to 37%). Only a small proportion of surgical and non-surgical patients met our definition of cure, with the vast majority demonstrating a constant or intermittent manifest deviation after an average of 7 years follow-up. In childhood intermittent XT, long-term cure is difficult to achieve with surgical intervention, and in some patients managed non-surgically the intermittent XT will spontaneously resolve.

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“…Using non-surgical treatment as adjunct to surgery, pre- or postoperatively, or both, has been advocated by some (Coffey 1992; France 1992; Veronneau-Troutman 1971). Presurgery, treatment to eliminate suppression and teach awareness of diplopia is thought to increase the likelihood of obtaining a cure.…”

Section: Introductionmentioning

confidence: 99%

Interventions for intermittent exotropia

Hatt

Gnanaraj

2013

Cochrane Database of Systematic Reviews

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Background The clinical management of intermittent exotropia has been discussed extensively in the literature, yet there remains a lack of clarity regarding indications for intervention, the most effective form of treatment and whether or not there is an optimal time in the evolution of the disease at which any treatment should be carried out. Objectives The objective of this review was to analyse the effects of various surgical and non-surgical treatments in randomised trials of participants with intermittent exotropia, and to report intervention criteria and determine the significance of factors such as age with respect to outcome. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 4, 2012), MEDLINE (January 1966 to May 2012), EMBASE (January 1980 to May 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 May 2012. We are no longer searching the UK Clinical Trials Gateway (UKCTG) for this review. We manually searched the British Orthoptic Journal up to 2002, and the proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) up to 2001. We contacted researchers who are active in the field for information about further published or unpublished studies. Selection criteria We included randomised controlled trials of any surgical or non-surgical treatment for intermittent exotropia. Data collection and analysis Each review author independently assessed study abstracts identified from the electronic and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained. Main results We found one randomised trial that was eligible for inclusion. This trial showed that unilateral surgery was more effective than bilateral surgery for correcting the basic type of intermittent exotropia. Authors’ conclusions The available literature consists mainly of retrospective case reviews, which are difficult to reliably interpret and analyse. The one randomised trial included found unilateral surgery more effective than bilateral surgery for basic intermittent exotropia. However, across all identified studies, measures of severity and thus criteria for intervention are poorly validated, and there appear to be no reliable natural history data. There is therefore a pressing need for improved measures of severity, a better understanding of the natural history and carefully planned clinical trials of treatment to improve the e...

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Treatment Options in Intermittent Exotropia: A Critical Appraisal

Cited by 53 publications

References 0 publications

A Randomized Trial Evaluating Short-term Effectiveness of Overminus Lenses in Children 3 to 6 Years of Age with Intermittent Exotropia

A Randomized Trial Evaluating Short-term Effectiveness of Overminus Lenses in Children 3 to 6 Years of Age with Intermittent Exotropia

Is intermittent exotropia a curable condition?

Interventions for intermittent exotropia

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