The Influence of Overminus Lens Therapy on Control of Intermittent Exotropia: A Meta-Analysis of Randomized Clinical Trials

Abstract

Background Intermittent exotropia (IXT) is the most common type of strabismus, overminus lens therapy (OML) is frequently prescribed to treat IXT. Objectives To compare the effectiveness of OML and observation in the treatment of intermittent exotropia. Method An exhaustive search of the literature in Pubmed, EMBASE, Web of Science, and Cochrane Library databases was performed until July 2022. No language restrictions were used. The literature was rigorously screened according to eligibility criteria. Weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated. Results A total of 4 articles with 561 participants were included in this meta-analysis. Our pooled results showed that OML demonstrated superior outcomes compared with observation, with greater decreases in distance and near exodeviation control (MD=-1.08, 95% CI: -1.96 to -0.20, P=0.02; OR, -0.64, 95%, -1.15 to -0.13; P < 0.001). Patients who received overminus lens therapy had a greater decrease in the deviation at both distance and near (OR, -2.88; 95% CI, -3.75 to -2.01, P < 0.001; OR, -3.44; 95% CI, -5.34 to -1.55; P < 0.001). There was no statistical difference between the two groups in terms of post-treatment proximal stereopsis (OR=0.01, 95% CI: -0.04 to 0.05, P=0.83). Conclusions The present meta-analysis indicated that overminus lens therapy was effective in improving the control and decreasing exodeviation angle of intermittent exotropia. However, it seemed not to be effective in improving the level of near stereopsis.

The efficacy of part-time patching treatment for intermittent exotropia on different age groups

“…Many studies were conducted on IXT patients to determine the effectiveness of patching therapy showed that most of the patients benefited from patching therapy either by improvement of the angle or delaying the need for surgery, 12,[16][17][18][19] on the other hand, our study did not find any significant difference in the angle of deviation at near and distance (p = 0.24 and p = 0.84 respectively) during the observation period. However, there was improvement in control in 34% of patients.…”

“…Our findings also showed that patients who had one hour of patching per day were more likely to need surgery than patients who had more than one hour of patching per day (2.5 HR, P-value = 0.02), this suggests that different daily duration of patching results in different outcomes, however more studies are required to assess the optimal daily duration of patching as it is variable in the literature. 19 The results of this study might encourage clinicians to focus more on counseling patients and their parents on the benefits of good compliance once patching therapy is prescribed to the patient. It may also encourage policy makers to make programs for screening and campaigns to raise awareness about IXT and the benefits of its early diagnosis and management.…”

Self-Reported Findings of the Korean Intermittent Exotropia Multicenter Study Questionnaire

“…-KIEMS writing committee (listed in alphabetical order of last name): Seung-Hee Baek, Hee-young Choi, Dong Gyu Choi, Dae Hee Kim, Dong Cheol Lee, Se-Youp Lee, Han Woong Lim, Hyun Taek Lim, Key Hwan Lim, Won Yeol Ryu, and Hee Kyung Yang -KIEMS investigators in the KAPOS (listed in the order of number of patients contributed by each investigator): Hee-young Choi 8 , Hyun Taek Lim 9 , Jae Ho Jung 10 , Seung-Hee Baek 11 , Mi Young Choi 12 , Jeong-Min Hwang 1 , Su Jin Kim 13 , Yeon-hee Lee 14 , Sueng-Han Han 15 , Shin Hae Park 2 , Haeng-Jin Lee 3 , Sook-Young Kim 4 , Se-Youp Lee 16 , Hyo jung Gye 5 , So Young Kim 6 , Sun Young Shin 2 , Jihyun Park 17 , Won Yeol Ryu 18 , Hye Sung Park 19 , Dae Hee Kim 11 , Hae Jung Paik 20 , Dong Gyu Choi 21 , Joo Yeon Lee 22 , Hee Kyung Yang 1 , Shin Yeop Oh 23 , Soo Jung Lee 24 , Seung Ah Chung 25 , Jin Choi 26 , Sei Yeul Oh 27 , Mirae Kim 28 , Young-Woo Suh 29 , Nam Yeo Kang 30 , Hae Ri Yum 31 , Sun A Kim 32 , Hyuna Kim 33 , Jinu Han 34 , Yoonae A. Cho 5 , Hyunkyung Kim 35 , Helen Lew 36 , Dong Cheol Lee 16 , Sang Hoon Rah 37 , Yung-Ju Yoo 38 , Key Hwan Lim 7 , Hyosook Ahn 9 , Ungsoo S. Kim 11…”

“…Past medical history: wearing glasses; duration, frequency, and laterality of occlusion therapy [15]; developmental delay, systemic or neurologic diseases, previous surgery; birth history including type of delivery, gestational age, and birth weight [16]; perinatal medical conditions.…”