Outcomes of office and home-based training vs part-time occlusion for intermittent exotropia management
Reviewed by Fiona Rowe

This study aimed to compare patch therapy with non-surgical treatment options for intermittent exotropia (IXT) using a synoptophore with/without simultaneous active orthoptic treatment and a maintenance treatment using computer-based gaming software. This 3-group trial recruited 72 patients. Intervention 1 (N=24) and 2 (N=24) involved office and home orthoptic treatment, anti-suppression using the synoptophore and open space exercise. Intervention 1 also included dichoptic game training. Office training was twice per week for 22 sessions. Home training was 1 hour per day, 5 days per week. The dichoptic game was on a smartphone and for 1 hour per day, 5 days per week for 4 weeks, and then reducing to 2 days per week. The control (N=24) was part-time occlusion for 2 hours per day for 6 months. Patients had IXT <40 prism dioptres with no vertical or pattern deviation and distance control score of 2 or worse (0 = best phoria control and 5 = worst with constant exotropia). Fifty-three completed treatment and follow-up of 6 months (18 group 1, 12 group 2, and 23 controls). There were 21 males and 32 females with mean age of 10.15 ±3.8 years. Those receiving intervention 2 had significantly better reduction in distance angle but all had significant improvement from baseline to 6 months at near and distance angles. Both intervention groups had significant improvement from baseline for near point of convergence as did the control group. However, differences were greater for the intervention groups. Only intervention 1 had significant improvement of accommodation amplitude and positive relative accommodation. Both interventions improved from baseline for negative relative accommodation and stereopsis, whilst controls did not. Limitations included the need for different levels of synoptophore training due to practicalities. There were large dropouts as the exercises increased and the study did not reach the sample size needed for statistical power. The results indicate combined office and home exercises may be more effective than part-time patching. Video games may have been helpful in improving accommodative amplitudes. Further study should consider a control group of home-based exercises only along with cost analysis for extra office-based attendance.

Combined office-based and home-based orthoptic training in the management of intermittent exotropia in children: a randomised clinical trial.
Hedayati M, Razavi ME, Sharif NM, et al.
STRABISMUS
2025;33(2):109–17.