A survey of clinical opinions and preferences on the non-surgical management of intermittent exotropia in China

Abstract

Purpose: Intermittent exotropia (IXT) is the most common form of childhood exotropia. Currently, controversies exist regarding its management and non-surgical options in particular. This study reports clinical opinions and preferences on the non-surgical management among practitioners in China. The opinions within and between ophthalmologists and optometrists were also compared. Design: Cross-sectional survey study. Methods: An online survey was developed and distributed through professional bodies. The study was conducted from July 25th to August 3rd, 2019. A total of 300 ophthalmologists and 188 optometrists responded. Results: Of 488 participants, 257 (53%) considered fusion defects as the main cause of IXT, and 299 (61%) took IXT as a progressive disorder. Two hundred and seventy-one (56%) participants considered orthoptic exercises as the most effective non-surgical intervention for IXT. Likewise, 245 (50%) participants reported that orthoptic exercises was their most frequent non-surgical option, followed by observation (178, 37%). There are discrepancies between ophthalmologists and optometrists. A greater proportion of ophthalmologists (201, 67%) shared the view that IXT worsens over time compared with optometrists (98, 52%) (p = 0.001). Additionally, ophthalmologists (121, 40%) tended to prefer observation compared with optometrists (57, 30%) (p = 0.021). Conclusions: This study shows that there is no general consensus on the non-surgical management of IXT in China. Given the lack of robust evidence, the findings from this study not only show the current clinical opinions but also highlight the need for future randomized clinical trials to validate the effectiveness of non-surgical interventions, orthoptic exercises in particular, and to establish treatment guidelines accordingly.

Effects of orthoptic therapy in children with intermittent exotropia after surgery: study protocol for a randomized controlled trial

“…Before the beginning of this study, we made a survey to the domestic ophthalmologists and optometrists [ 22 ]. The survey involved the design of some training program (e.g., time for each training, frequency of hospital training), which facilitated the development of this study.…”

“…We have conducted a survey about the clinical options on non-surgical management of IXTs in China. In total, 56% (271/488) participants are considered orthoptic treatment as the most effective non-surgical intervention [ 22 ]. So, there is an urgent need for randomized clinical trials to validate the effectiveness of orthoptic exercises and further to establish treatment guidelines accordingly.…”

Surgical treatment versus observation in moderate intermittent exotropia (SOMIX): study protocol for a randomized controlled trial

“…In clinical practice, the strabismus surgery can be performed in order to realign the eyes in severe IXT without binocular single vision (BSV). However, in children with mild IXT who have relatively normal BSV and good control of ocular alignment, the clinicians and parents prefer an observation rather than surgical or conservative treatments [12][13][14]. The best treatment and optimal timing of intervention for IXT remain unclear [15,16], particularly for children with moderate IXT who manifest obvious exodeviation frequently but with only partial impairment of BSV.…”