Presenting features and early
management of childhood intermittent exotropia in the UK: inception cohort study.
(Caractéristiques et traitement précoces des exotropies intermittentes au
Royaume uni)
Buck D, Powell C, Cumberland
P, Davis H, Dawson E, Rahi J, Sloper J, Taylor R, Tiffin P, Clarke MP; Improving
Outcomes in Intermittent Exotropia Study Group.
Institute of Health and Society, Newcastle University, Newcastle upon Tyne,
UK.
AIM: To investigate factors
associated with early management of intermittent exotropia (X(T)) in hospital
eye departments in the UK in a prospective cohort study.
METHODS: An inception cohort of 460 children aged <12 years with
previously untreated X(T) (mean age 3.6 years, 55.9% girls) was recruited from
26 UK hospital children's eye clinics and orthoptic departments. Participants
received a standard ophthalmic examination at recruitment and orthoptic
assessment at three-monthly intervals thereafter. The influence of severity of
exotropia (control measured by Newcastle Control Score (NCS), and angle of
strabismus, visual acuity and stereoacuity) and age on the type of management
was investigated.
RESULTS: Within the first 12 months following recruitment, 297 (64.6%)
children received no treatment, either for impaired visual acuity or for
strabismus. Ninety-six (21%) children had treatment for impaired visual acuity.
Eighty-nine (19.4%) received treatment for strabismus (22 of whom also received
treatment for defective visual acuity); in 54 (11.7%) treatment was non-surgical
and in 35 (7.6%) eye muscle surgery was performed. Children with poor (score
7-9) control of strabismus at recruitment were more likely to have surgery than
children with good (score 1-3) control (p<0.001). Children who had no treatment
were younger (mean age 3.38 years) than those who were treated (mean 4.07 years)
(p<0.001). Stereoacuity and size of the angle of strabismus did not influence
the type of management received.
CONCLUSIONS: X(T) can be a presenting sign of reduced visual acuity. Most
children with well controlled X(T) receive no treatment within 12 months
following presentation.
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