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First Visit Characteristics Associated with Future Surgery in Intermittent Exotropia
Jamaji C Nwanaji-Enwerem1,2, Taylor Gateman3, Sarah Whitecross3
1MD/PhD Program, Harvard Medical School, Boston, Massachusetts.
Insights
Age and control at initial presentation are key factors predicting surgery for intermittent exotropia (IXT). Older age and poor control increase the likelihood of needing surgery for this common childhood eye condition.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Research
Background:
- Intermittent exotropia (IXT) is a common childhood strabismus.
- Predicting the need for surgical intervention in IXT is crucial for effective management.
- Identifying early indicators can optimize treatment strategies.
Purpose of the Study:
- To identify demographic and clinical characteristics at initial presentation associated with later surgery for intermittent exotropia (IXT).
- To determine which factors predict the need for surgical intervention in children with IXT.
Main Methods:
- Retrospective cohort study of 228 children diagnosed with IXT.
- Analysis of demographic and clinical data from medical records.
- Comparison of surgical versus non-surgical groups using best subset regression and logistic models.
Main Results:
- Age and the degree of eye control at the first visit were significantly associated with undergoing surgery.
- Neither the angle of deviation nor stereopsis predicted the need for surgery.
- Older age at presentation correlated with decreased odds of surgery, while poor initial control significantly increased surgical odds.
Conclusions:
- Initial presentation age and the control of eye alignment are critical predictors for surgical intervention in IXT.
- The magnitude of the eye deviation and stereopsis are not significant factors in predicting future surgery for IXT.
Purpose:
Identify demographic and clinical characteristics at the first presentation associated with later having surgery for intermittent exotropia (IXT).
Methods:
Retrospective cohort study of 228 children with IXT and 5+ years of follow-up. Demographic and clinical data were extracted from medical records. A total 97 participants who underwent surgery during follow-up were compared to 131 participants who did not. Best subset regression was used to identify first visit variables associated with later having strabismus surgery. Surgery was then regressed on the selected variables using logistic models.
Results:
Age and control were the only first visit variables significantly associated with having surgery for IXT. Notably, neither angle of deviation nor stereopsis were associated with later surgery. In an adjusted logistic model, each one-month increase in age at presentation was associated with a 1% decrease in the odds of having surgery (OR = 0.991, 95% CI: 0.982-0.999, P = .04). Children with poor control at initial visit had almost five times greater odds of having surgery than those with good control (OR = 4.95, 95% CI: 2.31-10.98, P < .0001).
Conclusions:
Age and control of IXT are important factors at presentation associated with future surgical intervention for IXT. The magnitude of deviation and stereopsis was not significantly associated with future surgical treatment for IXT.
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