Background: The purpose of this study was to investigate current patterns of management and outcomes of\r\nintermittent distance exotropia [X(T)] in the UK.\r\nMethods: This was an observational cohort study which recruited 460 children aged < 12 years with previously\r\nuntreated X(T). Eligible subjects were enrolled from 26 UK hospital ophthalmology clinics between May 2005 and\r\nDecember 2006. Over a 2-year period of follow-up, clinical data were prospectively recorded at standard intervals\r\nfrom enrolment. Data collected included angle, near stereoacuity, visual acuity, control of X(T) measured with the\r\nNewcastle Control Score (NCS), and treatment. The main outcome measures were change in clinical outcomes\r\n(angle, stereoacuity, visual acuity and NCS) in treated and untreated X(T), 2 years from enrolment (or, where\r\napplicable, 6 months after surgery). Change over time was tested using the chi-square test for categorical,\r\nWilcoxon test for non-parametric and paired-samples t-test for parametric data.\r\nResults: At follow-up, data were available for 371 children (81% of the original cohort). Of these: 53% (195) had no\r\ntreatment; 17% (63) had treatment for reduced visual acuity only (pure refractive error and amblyopia); 13% (50)\r\nhad non surgical treatment for control (spectacle lenses, occlusion, prisms, exercises) and 17% (63) had surgery.\r\nOnly 0.5% (2/371) children developed constant exotropia. The surgically treated group was the only group with\r\nclinically significant improvements in angle or NCS. However, 8% (5) of those treated surgically required second\r\nprocedures for overcorrection within 6 months of the initial procedure and at 6-month follow-up 21% (13) were\r\novercorrected.\r\nConclusions: Many children in the UK with X(T) receive active monitoring only. Deterioration to constant\r\nexotropia, with or without treatment, is rare. Surgery appears effective in improving angle of X(T) and NCS, but\r\nrates of overcorrection are high.
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