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

    Observation looks favorable; overminus lenses have emerging promise


    His study also revealed the importance of retesting stereoacuity. “After we thought they had deteriorated, the majority returned to baseline stereoacuity, stressing the need for a retest of stereoacuity when following children with IXT,” he said.

    Retina Treatments Resource Center

    Part-time patching is also a treatment option for IXT. Dr. Holmes presented information from a randomized trial led by the Pediatric Eye Disease Investigator Group (PEDIG)3,4 where children ages 1 to 10 years old were randomized to observation including glasses or patching three hours a day.

    The primary outcome was assessed at six months. The study found a low rate of deterioration in younger children (1 and 2 year olds) in both the observed group (4.6%) and the group with patching (2.2%).4 This difference was not statistically significant. In older children (3 to 10 years old), the deterioration rate was 6% in the group that was observed and 0.6% in the group with patching.3

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    Although this was a larger difference, 4 of 10 deteriorations were questionable because three had started treatment prematurely and one of the patients who was deemed to have constant exotropia actually had excellent stereoacuity, suggesting the exotropia was not constant, Dr. Holmes said.

    The PEDIG study was scheduled to reach a 3-year completion at the end of December 2015, so further results will be available soon, Dr. Holmes said.

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    Another treatment option for IXT is overminus lens therapy, based on the idea of stimulating accommodation with additional minus power in the glasses, or allowing fusional vergence, with associated accommodation, where the overminus lenses allow clearer vision.

    The PEDIG group recently finished a pilot study—as yet unpublished—that included children who were 3 to 7 years old. The children were randomized to overminus lenses versus observation. The observed children used plano glasses for masked assessment of outcome, if not prescribed non-overminus glasses at the start of the study.

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    “We found that children assigned to overminus had better control at the end of the 8-week study, while wearing their glasses, than the observation group,” Dr. Holmes said.  A question from this study that remains unanswered is whether the overminus group children still have better control over the long term and particularly after treatment is discontinued.  A longer-term study is in the planning phase.

    Unanswered questions

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