Authors
Ma, Martin Ming-Leung BSc; Kang, Ying MD; Scheiman, Mitchell OD, PhD, FAAO; Chen, Xiang MS, PhD

Office-based Vergence and Accommodative Therapy for the Treatment of Intermittent Exotropia: A Pilot Study

publication date
September 21, 2019
Category
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Abstract/Introduction

SIGNIFICANCE 

This study will help to demonstrate the potential value of office-based vergence/accommodative therapy for the treatment of intermittent exotropia and provide data that can be used for planning future clinical trials.

 

PURPOSE 

This study was designed to evaluate changes in the office control score after office-based vergence/accommodative therapy for intermittent exotropia.

 

METHODS 

This was a prospective, unmasked pilot study. Fourteen Chinese participants aged 6 to 18 years with intermittent exotropia (excluding the convergence insufficiency type) were enrolled. All participants received 60 minutes of office-based vergence/accommodative therapy with home reinforcement once per week for 12 weeks. Therapy included vergence, accommodation, saccades and pursuits, antisuppression, and monocular fixation in binocular field techniques. The primary outcome measure was the change in the office control score from the baseline visit to the 13-week outcome visit.


Conclusion/Results

RESULTS 

All participants completed the study. The office control score at distance changed by −1.0 (95% confidence interval [CI] = −1.6 to −0.4; P = .005; Cohen's d effect size, 0.93). The distant Look And Cover, then Ten seconds Observation Scale for Exotropia score and distant Newcastle control score total score changed by −0.7 (95% CI, −1.2 to −0.2; P = .02; Cohen's d effect size, 0.55) and −1.9 (95% CI, −2.8 to −1.0; P < .001; Cohen's d effect size, 1.37), respectively. Although there was no significant change in the angle of distance exodeviation (−1.8 prism diopter [Δ] less exodeviation; 95% CI, −3.74 to 0.14Δ; P = .11), a significant change was observed in the near angle (−4.4Δ less exodeviation; 95% CI, −7.3 to −1.5Δ; P = .01; Cohen's d effect size, 0.79). There was no significant change in stereopsis or the Chinese Intermittent Exotropia Questionnaire score.

 

CONCLUSIONS 

In this select group of children with intermittent exotropia, 12 weeks of office-based vergence/accommodative therapy with home reinforcement resulted in a statistically and clinically significant improvement in the distance control of exodeviation and the near exodeviation magnitude. These results suggest that there is a need for a randomized clinical trial designed to determine the effectiveness of vision therapy as a treatment modality for intermittent exotropia.


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Testimonials


My eight year old daughter was terrified to go to the eye doctor for fear of her eyes being dilated. The doctor was SO KID friendly! He immediately made her comfortable by engaging her in conversation. It was a geat experience.


Joya B.

Dr. Garbus spent an amazing amount of time to solve my very complicated visual problems. Over the years he has continually achieved results beyond what others felt possible. He is always up to date on the latest science. He is great!


Dolores K.

Family Vision Care Valencia makes it so easy. Staff is knows what they are doing and Dr. Garbus is thorough and kept me well informed during the exam.


Kristy B.

I have been coming to Family Vision Center for almost 20 years. Dr. Garbus has been able to help my vision when other doctors could not. Now my kids see him as well. I highly recommend this office!


Autumn C.

The Doctor is very good. I felt on this visit he seemed rushed. I had questions to ask him but he was already with another patient. I still do not know if my eyes are the same , worse, or better.


Howard B.

All the staff is friendly, helpful and knowledgeable, and has been for all the years I have been going there.


Mary Ann H.
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