In the JournalsPerspective

Treatment may not be necessary in children with intermittent exotropia

Children 3 to 10 years old with intermittent exotropia are not likely to progress to constant exotropia and may improve spontaneously over 3 years, according to a study.

The observational study was carried out by the Pediatric Eye Disease Investigation Group (PEDIG) at 60 clinical sites in the U.S. and comprised 183 participants with previously untreated intermittent exotropia (IXT) and 400 seconds of arc (arcsec) or better near stereoacuity. They were followed up at 3 and 6 months after randomization, and then every 6 months for 3 years.

Motor or stereoacuity deterioration was observed during the follow-up period in 15% of the children, and this rate was probably an overestimation, according to the authors. In 12 out of 25 cases, treatment was begun due to reasons other than protocol-defined deterioration, including social concern, diplopia and headache.

A small but statistically significant improvement in distance and near stereoacuity, distance control and distance exodeviation magnitude was reported in the participants who were not treated over the 3-year follow up period, maybe due to increasing eye maturity among children younger than 6 years of age.

“Although treatment may be appropriate for psychosocial or symptomatic concerns, treatment is not necessary to prevent motor deterioration or loss of stereoacuity over a 3-year period for most young children with IXT,” the authors concluded. – by Michela Cimberle

Disclosure: The authors reported no relevant financial disclosures. 

Children 3 to 10 years old with intermittent exotropia are not likely to progress to constant exotropia and may improve spontaneously over 3 years, according to a study.

The observational study was carried out by the Pediatric Eye Disease Investigation Group (PEDIG) at 60 clinical sites in the U.S. and comprised 183 participants with previously untreated intermittent exotropia (IXT) and 400 seconds of arc (arcsec) or better near stereoacuity. They were followed up at 3 and 6 months after randomization, and then every 6 months for 3 years.

Motor or stereoacuity deterioration was observed during the follow-up period in 15% of the children, and this rate was probably an overestimation, according to the authors. In 12 out of 25 cases, treatment was begun due to reasons other than protocol-defined deterioration, including social concern, diplopia and headache.

A small but statistically significant improvement in distance and near stereoacuity, distance control and distance exodeviation magnitude was reported in the participants who were not treated over the 3-year follow up period, maybe due to increasing eye maturity among children younger than 6 years of age.

“Although treatment may be appropriate for psychosocial or symptomatic concerns, treatment is not necessary to prevent motor deterioration or loss of stereoacuity over a 3-year period for most young children with IXT,” the authors concluded. – by Michela Cimberle

Disclosure: The authors reported no relevant financial disclosures. 

    Perspective
    Stanley W. Hatch

    Stanley W. Hatch

    This paper reports the results of 152 of 183 subjects who completed a 3-year observation period or met predetermined deterioration outcome criteria. Only 15% (95% CI, 10% to 22%) met at least one criterion for deterioration.

    Key findings:

    --Subjects with low to moderate amplitude intermittent exotropia (IXT) rarely converted to constant XT.

    --IXT control and stereoacuity remained stable in the vast majority of subjects.

    Limitations:

    --Observational study of symptomatic IXT poses challenges to enrollment due to patients choosing treatment. 

    --There may have been differences in severity of IXT between subjects who withdrew or were lost to follow-up. 

    Limitations could have had a small impact on the rate of deterioration but are unlikely to alter the main conclusion that most patients with IXT retain binocular vision without treatment.

    • Stanley W. Hatch, OD, MPH
    • Chief, Pediatrics and Binocular Vision Service,
      Pennsylvania College of Optometry

    Disclosures: Hatch is a PEDIG investigator but did not participate in this study.