Abstract
BackgroundThe purpose of this study was to investigate current patterns of management and outcomes of intermittent distance exotropia [X(T)] in the UK.MethodsThis was an observational cohort study which recruited 460 children aged < 12 years with previously untreated X(T). Eligible subjects were enrolled from 26 UK hospital ophthalmology clinics between May 2005 and December 2006. Over a 2-year period of follow-up, clinical data were prospectively recorded at standard intervals from enrolment. Data collected included angle, near stereoacuity, visual acuity, control of X(T) measured with the Newcastle Control Score (NCS), and treatment. The main outcome measures were change in clinical outcomes (angle, stereoacuity, visual acuity and NCS) in treated and untreated X(T), 2 years from enrolment (or, where applicable, 6 months after surgery). Change over time was tested using the chi-square test for categorical, Wilcoxon test for non-parametric and paired-samples t-test for parametric data.ResultsAt follow-up, data were available for 371 children (81% of the original cohort). Of these: 53% (195) had no treatment; 17% (63) had treatment for reduced visual acuity only (pure refractive error and amblyopia); 13% (50) had non surgical treatment for control (spectacle lenses, occlusion, prisms, exercises) and 17% (63) had surgery. Only 0.5% (2/371) children developed constant exotropia. The surgically treated group was the only group with clinically significant improvements in angle or NCS. However, 8% (5) of those treated surgically required second procedures for overcorrection within 6 months of the initial procedure and at 6-month follow-up 21% (13) were overcorrected.ConclusionsMany children in the UK with X(T) receive active monitoring only. Deterioration to constant exotropia, with or without treatment, is rare. Surgery appears effective in improving angle of X(T) and NCS, but rates of overcorrection are high.
Highlights
The purpose of this study was to investigate current patterns of management and outcomes of intermittent distance exotropia [X(T)] in the UK
Intermittent distance exotropia [X(T)] is a form of early onset childhood strabismus, affecting around 32 per 100,000 of children aged under 19 years [1]
There is a lack of consensus on the appropriate timing of surgical treatment [11,12,13,14,15] which balances the risks of developing constant exotropia against those of persistent post-operative overcorrection
Summary
The purpose of this study was to investigate current patterns of management and outcomes of intermittent distance exotropia [X(T)] in the UK. Intermittent distance exotropia [X(T)] is a form of early onset childhood strabismus, affecting around 32 per 100,000 of children aged under 19 years [1]. It comprises periodic divergent misalignment [2,3] which is initially present on distance fixation, or during periods of tiredness or inattention alone, but may become more frequent and be present on near fixation, eventually leading to constant exotropia in some cases. There is a lack of consensus on the appropriate timing of surgical treatment [11,12,13,14,15] which balances the risks of developing constant exotropia against those of persistent post-operative overcorrection
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