Progression uncommon among untreated children with intermittent exotropia
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Stereoacuity deterioration or progression to constant exotropia was uncommon among children with intermittent exotropia who did not undergo surgical treatment, according to a study from the journal, Ophthalmology.
Brian G. Mohney, MD, department of ophthalmology at the Mayo Clinic, and colleagues wrote that intermittent exotropia (IXT), “which occurs in nearly 1% of children in the United States and up to 4% of children in Asia, generally manifests more frequently with distance viewing, illness or fatigue. Although common, there are minimal data regarding the natural history of this disorder.”
To describe the course of IXT without treatment, 183 children 3 to 10 years old with previously untreated IXT were included for analysis. Participants were examined for deterioration at 3 months, 6 months and at 6 month intervals thereafter for 3 years; no treatment was administered unless deterioration criteria were met.
Study results yielded 25 deteriorations: two motor deteriorations and 11 stereoacuity deteriorations, and 12 began treatments without meeting criteria. Among the 132 participants who reached study completion without treatment, less than 1% met motor or stereoacuity deteriorations.
Between baseline and 3-year follow-up, improvement occurred in distance and near stereoacuity (mean improvement, 0.14 and 0.14 logarithm of arcsec; P .001 and P .001, respectively), distance exotropia control (mean improvement, 0.6 points; P .001) and distance exodeviation magnitude (P = .002). Cumulative probability of protocol-specified deterioration was 15% (95% CI, 10% - 22%).
“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,” Mohney and colleagues concluded.
Perspective
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Mark Wu, OD, FAAO
This was one of the more recent studies conducted on intermittent exotropia by the Pediatric Eye Disease Investigator Group. The researchers examined the ocular posture stability of patients with intermittent exotropia over a period of 3 years without any treatment. They concluded that it is uncommon to see deterioration of intermittent exotropia if managed with only observation. Deterioration is defined by the study as progression from intermittent to constant exotropia, with or without reduction in stereoacuity. Having worked in both the binocular vision clinic and community clinics, I am not surprised with the results of the study that most cases of intermittent exotropia do remain stable over time without any surgical intervention or vision therapy. However, treatment options should always be discussed with patients with eye fatigue or cosmetic concerns so we can help improve our patients’ control of their exotropia.
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