| Part I Far distance control scores for assessing intermittent exotropiaPurpose:To assess the level of control in intermittent exotropia by applying the office-based 6-point control scale to far-distance testing.Methods:A prospective non-interventional case series.52 intermittent exotropia patients of the basic,divergence excess and pseudo-divergence excess type presenting to the Provincial Hospital affiliated to Shandong University and meeting the inclusion criteria from August 2014 to March 2015 were involved in our study.The mean age of 52 enrolled children(26 males,26 famale)was 7.5 years(range,5-12 years).The control scores of all patients were evaluated using an office-based 6-point control scale proposed by Mohney and Holmes',and in appropriate refractive correction if ametropia.For every patient we measure the control ability at four different distances,including a 3m distance(indoor distance ID)when the child fixating on a cartoon film and a 33cm distance(near distance)when the child fixating on an accommodation target,and here in our study we add two measurement distances:30m distance indoor(indoor far distance IFD)when the child fixating on a large stuffed cartoon toy interesting to him or her held by an assistant at the end of a long hallway(30 m),50m distance outdoor(outdoor far distance OFD)when the patient fixating on a fluttering flag 50 m away out of a window during daylight.We test the control scores of every interminttent exotropia patient 3-4 times in a single day with an interval at least 2 hours,in an order from far to near.For every patient we use the mean of 3 or 4 control score as the child's control score,compare the four control scores at different fixation distances.Deviations of patients at distance(6m)and at near(33cm)were measured by prism and alternate cover test before and after 1 hour's monocular occlusion.Results:In all 52 patients,before 1 hour of patching,the mean distance exodeviation(with standard deviation)was 29.3±9.6PD,and the mean near exodeviation was 24.8±10.8PD,after 1 hour of patching,the distance exodeviation was 30.22±10.6 PD,and the near exodeviation was 29.8±11.8 PD.There were 33 patients with basic type,4 patients with divergence excess type,and 15 patients with pseudo-divergence excess type EXT.The mean value of the control score for each fixation distance of 52 children was compared,the level of control at 50m distance outdoor fixation was either worse than(16 patients30.8%)or the same as(36 patients 69.2%)the level of control at 30m distance indoor fixation,and the level of control at 30m distance indoor fixation was worse than(33 patients 63.5%)or the same as(19 patients 36.5%)the level of control at 3m distance indoor fixation.The level of control at 50m distance outdoor fixation was worse than(36 patients,69.2%)or the same as(16 patients,30.8%)the level of control at 3m distance indoor fixation.The control at 50m distance outdoor fixation ranged from1 to 5,with a median of 3.42;the level of control at 30m distance indoor fixation from 1 to 5,with a median of 2.38;the level of control at 3m distance indoor fixation,from 1 to 5,with a median of 2;and that of near fixation,from 0 to4,with a median of 1.The differences between mean control scores of 50m distance outdoor and 30m distance indoor fixation(P =0.002),30m distance indoor and 3m distance indoor fixation(P<0.001),50m distance outdoor and 3m distance indoor fixation(P<0.001)were statistically significant.Conclusions:The outdoor and indoor far distance control scores can increase the sensitivity of the office-based 6-point control scale.The office control scale for assessing control in patients with intermittent exotropia could have application for the management of intermittent exotropia.Part II Correlations between distance stereoacuity and levels of control at different far distances in children with intermittentexotropiaPurpose:To study the correlations between the distance stereoacuity and the levels of control at different far distance fixations in children with intermittent exotropia.Methods:Fifty-two children with intermittent exotropia presenting to the Provincial Hospital affiliated to Shandong University and meeting the inclusion criteria from August 2014 to March 2015 were enrolled in this prospective,non-interventional case series.The mean age of 52 enrolled children(26 males,26 famale)was 7.5 years(range,5-12 years).Distance stereoacuity was assessed in using the Polaroid vectograph test DRS(Distance Randot Stereotest,stereoscopic Optical Co.,Inc.,Chicago,IL,performed at 3 meters)at a distance of 3 m,and before any dissociative testing.The control ability of exodeviation was assessed using the office-based 6-point control scale proposed by Mohney and Holmes,at outdoor far distance fixation(a flttering flag out of window)of 50 m,indoor far distance fixation(a large stuffed cartoon toy interesting to children)of 30 m,and indoor distance(a cartoon film)of 3 m,respectively.The control scores and distance stereoacuity of every interminttent exotropia child were tested 3-4 times in a single day with an interval at least 2 hours,and the distance stereoacuity was tested before control scores.The measurements of distance stereoauity and control scores were all assessed in appropriate refractive correction if ametropia.Results:There were positive correlations between the distance stereoacuity and the levels of control at outdoor far distance fixation of 50 m(r=0.489,99%CI,0.318-0.639),indoor far distance fixation of 30 m(r=0.472,99%CI,0.290-0.619),and indoor distance fixation of 3 m(r=0.282,99%CI,0.083-0.469)at the same assessment time point in children with intermittent exotropia.Conclusions:There were stronger correlations between the distance stereoacuity and the levels of control in patients with intermittent exotropia when fixing on targets at outdoor far distance of 50m and indoor far distance of 30m than that at indoor distance of 3m. |
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