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Stability of near stereoacuity in childhood intermittent exotropia
Jonathan M Holmes1, David A Leske, Sarah R Hatt
1Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA. holmes.jonathan@mayo.edu
Insights
Near stereoacuity deterioration is uncommon in children with untreated intermittent exotropia. Regular retesting is crucial, as apparent declines often resolve without intervention.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Binocular Vision
Background:
- Intermittent exotropia is a common childhood strabismus.
- The impact of untreated intermittent exotropia on near stereoacuity requires further investigation.
Purpose of the Study:
- To examine the natural course of near stereoacuity in children with untreated intermittent exotropia.
Main Methods:
- A cohort of 95 children (ages 2-16) with untreated intermittent exotropia were monitored.
- Near stereoacuity was assessed using the Preschool Randot (PSR) test over successive examinations.
- Deterioration was defined as a drop of at least 3 octaves, with secondary analyses using 2 octaves or normal-to-subnormal transitions.
Main Results:
- The rate of near stereoacuity deterioration (≥3 octaves) was low: 2% at 1 year and 7% at 2 years.
- Alternative analyses confirmed infrequent deterioration.
- Most instances of apparent stereoacuity decline resolved spontaneously without treatment.
Conclusions:
- Deterioration of near stereoacuity is infrequent in children with untreated intermittent exotropia.
- Proactive surgical intervention solely to prevent stereoacuity loss is not supported.
- Serial stereoacuity testing is essential to confirm genuine deterioration.
Purpose:
To investigate the course of near stereoacuity in a cohort of children with untreated intermittent exotropia.
Methods:
A total of 95 children ages 2-16 years with untreated intermittent exotropia were identified who had measurements of near stereoacuity using the Preschool Randot (PSR) test on at least 2 successive examinations, with no intervening treatment. Deterioration was defined as a drop of at least 3 octaves, as determined by test-retest data. Alternative secondary analyses were performed defining deterioration as a drop of at least 2 octaves or as a transition from normal to subnormal. The main outcome measure was the deterioration rate calculated at 1 and 2 years using a Kaplan-Meier survival analysis.
Results:
For near stereoacuity, the rate of decreasing 3 or more octaves was 2% (95% CI, 0%-6%) at 1 year and 7% (95% CI, 0%-16%) at 2 years. The alternative secondary analyses revealed similar low deterioration rates. In most cases of apparent deterioration, near stereoacuity returned to baseline levels without treatment.
Conclusions:
For children with untreated intermittent exotropia, deterioration in near stereoacuity at 1 and 2 years is infrequent. Therefore, performing surgery for intermittent exotropia to proactively prevent deterioration of near stereoacuity cannot be justified. Retesting stereoacuity is critical to determine whether any measured decrease in stereoacuity is real.
