Combined office-based and home-based orthoptic training in the management of intermittent exotropia in children: a randomized clinical trial.

Abstract

Purpose: To compare the effect of combinational office-based and home-based orthoptic training regimens with part-time patching in participants with intermittent exotropia. Methods: In a randomized clinical trial study, patients with a diagnosis of IXT were involved and randomly assigned to three groups. Patients in the control group were followed with part-time patch therapy. For the Intervention 1 group, in-office and home-based orthoptic training was prescribed along with playing with a video game software (PIVOT). For Intervention 2 group the same management protocol was incorporated except using the video game software. Evaluation of the control scale and degree of deviation, accommodation, convergence, and stereopsis was performed at baseline and at 1.5 months, 3 months, and 6 months follow-ups. Results: A total of 53 patients (21 males and 32 females) with a mean age of 10.15 ± 3.80 years (range 5-18 years) completed the treatment and follow-up visits. The angle of deviation at distance decreased significantly in all groups (p < .05). No significant reduction of near angle of deviations was found in the control group (p = .38). In the intervention groups, positive fusional vergence (PFV), stereopsis, near point of convergence (NPC), and control scale of deviation at distance improved significantly compared to the control group (all, p < .05). At six months follow-up, patients in the Int 1. group showed significantly increased amplitude of accommodation and positive relative accommodation (PRA) compared to the patients in the Int 2. and control groups (all, p < .05). Conclusion: Compared to part-time patch therapy, orthoptic training is more effective in the management of children with IXT. Using video games as a home-based therapy can improve accommodative abilities in these patients.