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Part-time patching shows no benefit in treating intermittent exotropia
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Part-time patching was shown to be no more effective than observation among children between the ages of 12 months and 35 months with intermittent exotropia, according to a study.
The randomized, multicenter clinical trial included 201 children with intermittent exotropia who had no previous treatment other than refractive correction. Average patient age was 24.6 months.
Patients were randomly assigned to observation with no patching for 6 months (97 patients) or patching for 3 hours daily for 5 months and no patching for 1 month (104 patients).
Follow-up examinations were conducted 3 months and 6 months after randomization; 177 patients completed 6 months of follow-up.
The main outcome measure was deterioration, described as constant exotropia of at least 10 ∆D at distance and near, or if another treatment for intermittent exotropia was prescribed.
Deterioration of intermittent exotropia occurred in four patients in the observation group (4.6%) and two patients in the patching group (2.2%). Motor deterioration occurred in two patients in the observation group (2.3%) and two patients in the patching group (2.2%). The differences were not statistically significant.
Mean prism and alternate cover test (PACT) measurements at distance were 27.9 ∆D in the observation group and 24.9 ∆D in the patching group (P = .02). Mean PACT measurements at near were 19.3 ∆D in the observation group and 17 ∆D in the patching group, which was not a significant difference.
Six-month mean exotropia control scores at distance were 2.8 in the observation group and 2.3 in the patching group (P = .02). Mean control scores at near were 1.4 in the observation group and 1.1 in the patching group, which was not a significant difference. – by Matt Hasson
Disclosure: The authors report no relevant financial disclosures.
Perspective
Back to TopScott E. Olitsky, MD
There are many potential treatment options for patients with intermittent exotropia. Even among those ophthalmologists who feel that surgery is the best long-term option, there is debate regarding the timing of surgical intervention. One concern is that early surgery with an overcorrection could lead to loss of binocular vision. However, delaying surgery and allowing the deviation to become manifest more frequently could do the same. The study by the PEDIG group shows that part-time occlusion, which has been proposed to delay progression of intermittent exotropia, appears to be ineffective at doing so during a follow-up period of 6 months in younger patients.
There are several limitations of the study, which the group notes. These include a small sample size, some patients who did not follow up during the study, and a relatively short study period for a disorder that tends to worsen gradually over a longer period of time. The study also does not specifically address the role of part-time patching in patients who have started to deteriorate and if this treatment could slow that deterioration. Although it does answer some specific questions about the efficacy of part-time patching in the treatment of intermittent exotropia, it leaves many others still unanswered.
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Mohney BG, et al. Ophthalmology. 2015;doi:10.1016/j.ophtha.2015.04.025.
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