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    What's the best non-surgical treatment for exotropia?

    Observation looks favorable; overminus lenses have emerging promise

    Take home: Observation, patching, and the use of overminus lenses are three treatment approaches for intermittent exotropia; observation appears reasonable based on current research.

    Observation appears to be a very reasonable option at this point for children with intermittent exotropia (IXT), said Jonathan M. Holmes, MD, Mayo Clinic, Rochester, Minn.

    Dr. Holmes summarized recent research related to the non-surgical management of IXT including observation, patching, and overminus glasses.

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    Dr. Holmes focused his analysis on larger and more recent trials and observational studies.

    Regarding observation, Dr. Michael Clarke’s research group in England enrolled 460 children in a prospective study in which more than half of the children were only observed.1

    Visit the Ophthalmology Times Retina Homepage

    “He found that 85% of children had no change in their level of control if just observed over a 2-year period,” Dr. Holmes said.

    In patients only observed, the mean near stereoacuity improved, and the mean angle of deviation did not change. Less than one percent of patients in Dr. Clarke’s study developed constant IXT. However, there was one caveat: “This study was not population-based, and children were not randomized to their treatment assignment,” Dr. Holmes said.

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    In a study led by Dr. Holmes2 that included 95 children observed over two years, the rate of deterioration of near stereoacuity (three or more octave levels) was only 2% at year one and 7% at year two.

    Importance of retesting stereoacuity

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