Corrective surgery improves visual motor and visual perception skills in children with intermittent exotropia

This study reveals that children with intermittent exotropia (IXT) demonstrate subtle but measurable impairments in visual motor and visual perceptual skills. Importantly, strabismus surgery may yield functional gains in these domains, providing clinical insights beyond ocular alignment outcomes.

To assess visual motor and visual perception skills in children with IXT compared with matched controls, and evaluate post-operative changes after surgical intervention.

Prospective longitudinal case-control study. Visual motor and visual perception were evaluated using the Beery Visual Motor Integration 6th ed. and the Test of Visual Perception Skill, 4th ed. A 1-year post-operative follow-up was conducted for the IXT group.

A total of 61 children with basic-type IXT (mean age: 9.6 ± 1.9 years; 38 boys) and 40 age-and sex-matched controls (mean age: 9.6 ± 1.7 years; 23 boys) were included. Among the IXT cohort, 27 underwent strabismus surgery and 34 were observed. One-year follow-up was completed by 22 surgical patients, 18 observation patients, and 28 controls. At baseline, children with IXT scored significantly lower than controls on visual motor integration (106.4 ± 11.9 vs. 112.4 ± 9.4, p=0.01), motor coordination (104.8 ± 10.7 vs. 112.4 ± 9.4, p=0.001), and perceptual subtests including form constancy (109.8 ± 12.0 vs. 115.5 ± 11.4, p=0.01) and visual closure (109.1 ± 11.5 vs. 116.6 ± 10.4, p=0.001). At 1-year follow-up, the surgical group showed significant improvements in visual motor integration (mean change: +8.7, p=0.01), motor coordination (+3.7, p=0.04), and form constancy (+6.5, p=0.04), while no changes were observed in the observation or control groups. Analysis of covariance, using the 1-year change from baseline as the outcome, revealed significant group differences in visual motor integration (p=0.02), visual discrimination (p=0.04), and sequential memory (p=0.002), with the surgical group demonstrating greater improvement in visual motor integration compared with the observation group (p=0.03).

Children with IXT exhibit functional deficits in the visual motor and perceptual domains. Surgical alignment may lead to improvements in select functions beyond ocular correction, supporting its potential role in enhancing visual cognitive development.