Vision Therapy Exercises Improve Intermittent Exotropia Control in Children

Both alternate part-time patching and pencil push-up training demonstrate efficacy as treatments for improving intermittent exotropia control in pediatric patients, according to a study published in BMC Ophthalmology.

Researchers enrolled 92 children (57 girls; mean age, 5.23 years) with previously untreated intermittent exotropia into a treatment study and randomly assigned them to treatment with pencil push-ups (n=30), patching (n=28), or observation (n=34). Patients underwent comprehensive ophthalmic examinations which included stereoacuity assessment at 40 cm. Distance (6m) and near (33 cm) measurements of exodeviation control were obtained using a 6-point office control scale (0, no exotropia unless dissociated, recovers in<1 second; 5, constant exotropia). 

Children assigned to patching treatment wore a patch on their dominant eye for 4 days and on their nondominant eye for 3 days per week, 2 hours per day. Those with equal eye dominance alternately covered their eyes for 2 hours every day. Patients treated with pencil push-ups performed 3 sets of 20 repetitions of the exercise for 5 days per week. Treatment duration was 12 weeks. 

Distance control improved significantly among individuals in both treatment groups as evidenced by decreasing office control scores at the study conclusion compared with baseline (patching: 1.6 vs 2.8; P <.001; pencil push-ups: 2.0 vs 3.1; P =.002). No significant changes in control score occurred among participants in the observational group (baseline: 2.8; conclusion: 2.6; P =.486) and no significant changes were noted for near control or stereopsis (P =.134).  

Compliance was good or excellent among 83% of patients treated with patching and 80% of children treated with pencil push-ups.

“There was a significant improvement in the distance control score after 12 weeks of patching and pencil push-up training compared to observation in children ages 5 to 7 years old,” according to the investigators. “Rather than using observation as a sole treatment modality, this study suggests that non-surgical treatment like alternate patching or pencil push-ups might be beneficial to young patients with intermittent exotropia.”

Limitations include a short study duration.