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Review Article

Divergence excess and basic exotropia types of intermittent exotropia: a major review. Part 1: prevalence, classification, risk factors, natural history and clinical characteristics

, BSc, PhDORCID Icon & , PhD

References

  • Govindan M, Mohney B, Diehl N, Burke J. Incidence and types of childhood exotropia: a population-based study. Ophthalmology. 2005;112(1):104–108. doi:10.1016/j.ophtha.2004.07.033.
  • Friedman DS, Repka MX, Katz J, et al. Prevalence of amblyopia and strabismus in white and African American children aged 6 through 71 months the Baltimore pediatric eye disease study. Ophthalmology. 2009;116(11):2128–2134.e2. doi:10.1016/j.ophtha.2009.04.034.
  • Multi-ethnic Pediatric Eye Disease Study Group. Prevalence of amblyopia and strabismus in African American and hispanic children ages 6 to 72 months. Ophthalmology. 2008;115(7):1229–1236.e1. doi:10.1016/j.ophtha.2007.08.001.
  • Chia A, Dirani M, Chan YH, et al. Prevalence of amblyopia and strabismus in young Singaporean Chinese children. Investig Opthalmol Vis Sci. 2010;51(7):3411. doi:10.1167/iovs.09-4461.
  • McKean-Cowdin R, Cotter SA, Tarczy-Hornoch K, et al. Prevalence of amblyopia or strabismus in Asian and non-hispanic white preschool children. Ophthalmology. 2013;120(10):2117–2124. doi:10.1016/j.ophtha.2013.03.001.
  • Pan CW, Zhu H, Yu JJ, et al. Epidemiology of intermittent exotropia in preschool children in China. Optom Vis Sci. 2016;93(1):57–62. doi:10.1097/OPX.0000000000000754.
  • Yamada T, Hatt SR, Leske DA, Holmes JM. Health-related quality of life in parents of children with intermittent exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2011;15(2):135–139. doi:10.1016/j.jaapos.2010.11.020.
  • Hatt SR, Leske DA, Liebermann L, Holmes JM. Symptoms in children with intermittent exotropia and their impact on health-related quality of life. Strabismus. 2016;24(4):139–145. doi:10.1080/09273972.2016.1242640.
  • Chia A, Seenyen L, Long QB. A retrospective review of 287 consecutive children in Singapore presenting with intermittent exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2005;9(3):257–263. doi:10.1016/j.jaapos.2005.01.007.
  • Hiles D, Davies G, Costenbader F. Long-term observations on unoperated intermittent exotropia. Arch Ophthalmol. 1968;80(4):436–442. doi:10.1001/archopht.1968.00980050438006.
  • Romanchuk KG, Dotchin SA, Zurevinsky J. The natural history of surgically untreated intermittent exotropia—looking into the distant future. J Am Assoc Pediatr Ophthalmol Strabismus. 2006;10(3):225–231. doi:10.1016/j.jaapos.2006.02.006.
  • Chen X, Fu Z, Yu J, et al. Prevalence of amblyopia and strabismus in Eastern China: results from screening of preschool children aged 36–72 months. Br J Ophthalmol. 2016;100(4):515–519. doi:10.1136/bjophthalmol-2015-306999.
  • Matsuo T, Matsuo C. The prevalence of strabismus and amblyopia in Japanese elementary school children. Ophthalmic Epidemiol. 2005;12(1):31–36. doi:10.1080/09286580490907805.
  • Robaei D, Rose KA, Kifley A, Cosstick M, Ip JM, Mitchell P. Factors associated with childhood strabismus. Findings from a population-based study. Ophthalmology. 2006;113(7):1146–1153. doi:10.1016/j.ophtha.2006.02.019.
  • Fu J, Li SYSM, Liu LR, et al. Prevalence of amblyopia and strabismus in a population of 7th-grade junior high school students in central China: the Anyang childhood eye study (ACES). Ophthalmic Epidemiol. 2014;21(3):197–203. doi:10.3109/09286586.2014.904371.
  • Lingham G, Mackey DA, Sanfilippo PG, et al. Influence of prenatal environment and birth parameters on amblyopia, strabismus, and anisometropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2020;24(2): e74.1–.e74.7. doi:10.1016/j.jaapos.2019.12.013.
  • Donnelly UM, Stewart NM, Hollinger M. Prevalence and outcomes of childhood visual disorders. Ophthalmic Epidemiol. 2005;12(4):243–250. doi:10.1080/09286580590967772.
  • Zhu H, Yu J-J, Yu R-B, et al. Association between childhood strabismus and refractive error in Chinese preschool children. Pan C-W, ed. PLoS One. 2015;10:e0120720.
  • Mohney BG, Huffaker RK. Common forms of childhood exotropia. Ophthalmology. 2003;110(11):2093–2096. doi:10.1016/j.ophtha.2003.04.001.
  • Yu CBO, Fan DSP, Wong VWY, Wong CY, Lam DSC. Changing patterns of strabismus: a decade of experience in Hong Kong. British Journal Of Ophthalmology. 2002;86(8):854–856. doi:10.1136/bjo.86.8.854.
  • Torp-Pedersen T, Boyd HA, Skotte L, et al. Strabismus incidence in a Danish population-based cohort of children. JAMA Ophthalmol. 2017;135(10):1047. doi:10.1001/jamaophthalmol.2017.3158.
  • Jenkins RH. Demographics: geographic variations in the prevalence and management of exotropia. Am Orthopt J. 1992;42(1):82–87. doi:10.1080/0065955X.1992.11981899.
  • Hashemi H, Pakzad R, Heydarian S, et al. Global and regional prevalence of strabismus: a comprehensive systematic review and meta-analysis. Strabismus. 2019;27(2):54–65. doi:10.1080/09273972.2019.1604773.
  • Martinez-Thompson JM, Diehl NN, Holmes JM, Mohney BG. Incidence, types, and lifetime risk of adult-onset strabismus. Ophthalmology. 2014;121(4):877–882. doi:10.1016/j.ophtha.2013.10.030.
  • Nusz KJ, Mohney BG, Diehl NN. Female predominance in intermittent exotropia. Am J Ophthalmol. 2005;140(3):546–547. doi:10.1016/j.ajo.2005.03.026.
  • Jampolsky A. Differential diagnostic characteristics of intermittent exotropia and true exophoria. Am Orthopt J. 1954;4(1):48–55. doi:10.1080/0065955X.1954.11981106.
  • Lancaster WB. Terminology in ocular motility and allied subjects. Am J Ophthalmol. 1943;26(2):122–132. doi:10.1016/S0002-9394(43)91519-3.
  • Knapp P. Intermittent exotropia: evaluation and therapy. Am Orthopt J. 1953;3(1):27–33. doi:10.1080/0065955X.1953.11981081.
  • Duane A. A new classification of the motor anomalies of the eye based upon physiological principles: together with their symptoms, diagnosis and treatment.
  • Burian HM. Exodeviations: their classification, diagnosis and treatment. Am J Ophthalmol. 1966;62(6):1161–1166. doi:10.1016/0002-9394(66)92570-0.
  • Burian HM, Franceschetti AT. Evaluation of diagnostic methods for the classification of exodeviations. Am J Ophthalmol. 1971;71(1):34–41. doi:10.1016/0002-9394(71)91091-9.
  • Burian HM, Spivey BE. The surgical management of exodeviations. Trans Am Ophthalmol Soc. 1964;62:276–306.
  • Kushner BJ. Exotropic deviations: a functional classification and approach to treatment. Am Orthopt J. 1988;38(1):81–93. doi:10.1080/0065955X.1988.11981775.
  • Abroms AD, Mohney BG, Rush DP, Parks MM, Tong PY. Timely surgery in intermittent and constant exotropia for superior sensory outcome. Am J Ophthalmol. 2001;131(1):111–116. doi:10.1016/S0002-9394(00)00623-1.
  • Hunter DG, Kelly JB, Buffenn AN, Ellis FJ. Long-term outcome of uncomplicated infantile exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2001;5(6):352–356. doi:10.1067/mpa.2001.120175.
  • Reynolds JD, Wackerhagen M. Early onset exodeviations. Am Orthopt J. 1988;38(1):94–100. doi:10.1080/0065955X.1988.11981776.
  • Nixon RB, Helveston EM, Miller K, Archer SM, Ellis FD. Incidence of strabismus in neonates. Am J Ophthalmol. 1985;100(6):798–801. doi:10.1016/S0002-9394(14)73370-7.
  • Cooper J, Duckman R. Convergence insufficiency: incidence, diagnosis, and treatment. J Am Optom Assoc. 1978;49:673–680.
  • Maconachie GDE, Gottlob I, McLean RJ. Risk factors and genetics in common comitant strabismus: a systematic review of the literature. JAMA Ophthalmol. 2013;131(9):1179–1186. doi:10.1001/jamaophthalmol.2013.4001.
  • Cotter SA, Varma R, Tarczy-Hornoch K, et al. Risk factors associated with childhood strabismus: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology. 2011;118(11):2251–2261. doi:10.1016/j.ophtha.2011.06.032.
  • Williams C, Northstone K, Howard M, Harvey I, Harrad RA, Sparrow JM. Prevalence and risk factors for common vision problems in children: data from the ALSPAC study. Br J Ophthalmol. 2008;92(7):959–964. doi:10.1136/bjo.2007.134700.
  • Podgor MJ, Remaley NA, Chew E. Associations between siblings for esotropia and exotropia. Arch Ophthalmol. 1996;114(6):739–744. doi:10.1001/archopht.1996.01100130731018.
  • Chew E, Remaley NA, Tamboli A, Zhao J, Podgor MJ, Klebanoff M. Risk factors for esotropia and exotropia. Arch Ophthalmol. 1994;112(10):1349–1355. doi:10.1001/archopht.1994.01090220099030.
  • Yang Y, Wang C, Gan Y, et al. Maternal smoking during pregnancy and the risk of strabismus in offspring: a meta-analysis. Acta Ophthalmol. 2019;97(4):353–363. doi:10.1111/aos.13953.
  • Torp-Pedersen T, Boyd HA, Poulsen G, et al. In-utero exposure to smoking, alcohol, coffee, and tea and risk of strabismus. Am J Epidemiol. 2010;171(8):868–875. doi:10.1093/aje/kwq010.
  • Fieß A, Kölb-Keerl R, Schuster AK, et al. Prevalence and associated factors of strabismus in former preterm and full-term infants between 4 and 10 Years of age. BMC Ophthalmol. 2017;17(1):1–9. doi:10.1186/s12886-017-0605-1.
  • Torp-Pedersen T, Boyd HA, Poulsen G, et al. Perinatal risk factors for strabismus. Int J Epidemiol. 2010;39(5):1229–1239. doi:10.1093/ije/dyq092.
  • Huynh SC, Wang XY, Ip J, et al. Prevalence and associations of anisometropia and aniso-astigmatism in a population based sample of 6 year old children. Br J Ophthalmol. 2006;90(5):597–601. doi:10.1136/bjo.2005.083154.
  • Tang SM, Chan RYT, Bin Lin S, et al. Refractive errors and concomitant strabismus: a systematic review and meta-analysis. Sci Rep. 2016;6(1):35177. doi:10.1038/srep35177.
  • Schlossman A, Priestley BS. Role of heredity in etiology and treatment of strabismus. Arch Ophthalmol. 1952;47(1):1–20. doi:10.1001/archopht.1952.01700030004001.
  • McKean-Cowdin R, Varma R, Cotter SA, et al. Risk factors for astigmatism in preschool children. Ophthalmology. 2011;118(10):1974–1981. doi:10.1016/j.ophtha.2011.06.031.
  • Buncher CR. Cigarette smoking and duration of pregnancy. Am J Obstet Gynecol. 1969;103(7):942–946. doi:10.1016/S0002-9378(16)34443-X.
  • O’Connor AR. Strabismus in children of birth weight less than 1701 g. Arch Ophthalmol. 2002;120(6):767. doi:10.1001/archopht.120.6.767.
  • Bagheri M, Farvardin M, Saadat M. A study of consanguineous marriage as a risk factor for developing comitant strabismus. J Community Genet. 2015;6(2):177–180. doi:10.1007/s12687-015-0213-9.
  • Rosenbaum AL, Stathacopoulos RA. Subjective and objective criteria for recommending surgery in intermittent exotropia. Am Orthopt J. 1992;42(1):46–51. doi:10.1080/0065955X.1992.11981894.
  • Buck D, Powell CJ, Rahi J, et al. The improving outcomes in intermittent exotropia study: outcomes at 2 years after diagnosis in an observational cohort. BMC Ophthalmol. 2012;12(1):6–13. doi:10.1186/1471-2415-12-1.
  • Mohney BG, Cotter SA, Chandler DL, et al. Three-year observation of children 3 to 10 years of age with untreated intermittent exotropia. Ophthalmology. 2019;126(9):1249–1260. doi:10.1016/j.ophtha.2019.01.015.
  • Cotter SA, Mohney BG, Chandler DL, et al. Three-year observation of children 12 to 35 months old with untreated intermittent exotropia. Ophthalmic Physiol Opt. 2020;40(2):202–215. doi:10.1111/opo.12668.
  • Na KH, Kim SH. Comparison of clinical features and long-term surgical outcomes in infantile constant and intermittent exotropia. J Pediatr Ophthalmol Strabismus. 2016;53(2):99–104. doi:10.3928/01913913-20160122-05.
  • Buck D, Powell C, Cumberland P, et al. Presenting features and early management of childhood intermittent exotropia in the UK: inception cohort study. Br J Ophthalmol. 2009;93(12):1620–1624. doi:10.1136/bjo.2008.152975.
  • Nusz KJ, Mohney BG, Diehl NN. The course of intermittent exotropia in a population-based cohort. Ophthalmology. 2006;113(7):1154–1158. doi:10.1016/j.ophtha.2006.01.033.
  • Rutstein RP, Corliss DA. The clinical course of intermittent exotropia. Optom Vis Sci. 2003;80(9):644–649. doi:10.1097/00006324-200309000-00009.
  • Lee BJ, Kim SJ, Yu YS. The clinical course of intermittent exotropia with small initial deviation. J Pediatr Ophthalmol Strabismus. 2015;52(4):206–212. doi:10.3928/01913913-20150520-01.
  • Kwok JJSW, Chong GSL, Ko STC, Yam JCS. The natural course of intermittent exotropia over a 3-year period and the factors predicting the control deterioration. Sci Rep. 2016;6(1):6–11. doi:10.1038/srep27113.
  • Antona B, Barrio A, Barra F, Gonzalez E, Sanchez I. Repeatability and agreement in the measurement of horizontal fusional vergences. Ophthalmic Physiol Opt. 2008;28(5):475–491. doi:10.1111/j.1475-1313.2008.00583.x.
  • Hatt SR, Haggerty H, Buck D, Adams W, Strong NP, Clarke MP. Distance stereoacuity in intermittent exotropia. Br J Ophthalmol. 2007;91(2):219–221. doi:10.1136/bjo.2006.099465.
  • Holmes JM, Leske DA, Hatt SR, Brodsky MC, Mohney BG. Stability of near stereoacuity in childhood intermittent exotropia. J AAPOS. 2011;15(5):462–467. doi:10.1016/j.jaapos.2011.06.008.
  • Simons K. Stereoacuity norms in young children. Arch Ophthalmol. 1981;99(3):439–445. doi:10.1001/archopht.1981.03930010441010.
  • Yoo G, Ha SG, Kim SH. Distance suppression as a predictive factor in progression of intermittent exotropia. Korean J Ophthalmol. 2019;33(5):446–450. doi:10.3341/kjo.2019.0054.
  • Windsor CE. Surgery, fusion, and accommodative convergence in exotropia. Int Ophthalmol Clin. 1971;11(4):46–52. doi:10.1097/00004397-197101140-00008.
  • Cooper J, Medow N. Major review: intermittent exotropia basic and divergence excess type. Binocular Vis Eye Muscle Surg Quartely. 1993;8:185–216.
  • Chiu AKC, Din N, Ali N. Standardising reported outcomes of surgery for intermittent exotropia – a systematic literature review. Strabismus. 2014;22(1):32–36. doi:10.3109/09273972.2013.877940.
  • Jung JW, Lee SY. A comparison of the clinical characteristics of intermittent exotropia in children and adults. Korean J Ophthalmol. 2010;24(2):96–100. doi:10.3341/kjo.2010.24.2.96.
  • Economides JR, Adams DL, Horton JC. Variability of ocular deviation in strabismus. JAMA Ophthalmol. 2016;134(1):63–69. doi:10.1001/jamaophthalmol.2015.4486.
  • Yehezkel O, Belkin M, Jaffe TW. Automated diagnosis and measurement of strabismus in children. Am J Ophthalmol. 2020;213:226–234. doi:10.1016/j.ajo.2019.12.018.
  • Sung JY, Yang HK, Hwang JM. Comparison of surgery versus observation for small angle intermittent exotropia. Sci Rep. 2020;10(1):1–8. doi:10.1038/s41598-020-61568-0.
  • Livir-Rallatos G, Gunton KB, Calhoun JH. Surgical results in large-angle exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2002;6(2):77–80. doi:10.1067/mpa.2002.122059.
  • Yang HK, Hwang JM. The effect of target size and accommodation on the distant angle of deviation in intermittent exotropia. Am J Ophthalmol. 2011;151(5):907–913.e1. doi:10.1016/j.ajo.2010.11.021.
  • Le T, Koklanis K, Georgievski Z. The fixation target influences the near deviation and AC/A ratio in intermittent exotropia. J AAPOS. 2010;14(1):25–30. doi:10.1016/j.jaapos.2009.11.014.
  • Kim C, Hwang J-M. ‘Largest angle to target’ in surgery for intermittent exotropia. Eye. 2005;19(6):637–642. doi:10.1038/sj.eye.6701604.
  • Kushner BJ. The distance angle to target in surgery for intermittent exotropia. Arch Ophthalmol. 1998;116(2):189–194. doi:10.1001/archopht.116.2.189.
  • Algee K, Walsh L, Hahn E. A comparison of the maximum deviation measured in intermittent exotropia using various clinical conditions. J Binocul Vis Ocul Motil. 2019;69(2):73–81. doi:10.1080/2576117X.2019.1607428.
  • Daum KM. Characteristics of exodeviations: II. Changes with treatment with orthoptics. Am J Optom Physiol Opt. 1986;63(4):244–251. doi:10.1097/00006324-198604000-00002.
  • Burian H, Smith D. Comparative measurement of exodeviations at twenty and one hundred feet. Trans Am Ophthalmol Soc. 1971;69:188–199.
  • Wang H, Liu G, Pan X, Huang W. Comparative measurements of exodeviations in the three types of intermittent exotropia. Int J Ophthalmol. 2014;14:2162–2164.
  • Stager DR, Everett M. Comparison of strabismus measurements in mirrored and twenty foot lanes. Am Orthopt J. 1987;37(1):74–76. doi:10.1080/0065955X.1987.11981738.
  • Kushner BJ. Distance/near differences in intermittent exotropia. Arch Ophthalmol. 1998;116(4):478. doi:10.1001/archopht.116.4.478.
  • Cooper J, Ciuffreda KJ, Kruger PB. Stimulus and response AC/A ratios in intermittent exotropia of the divergence-excess type. Br J Ophthalmol. 1982;66(6):398–404. doi:10.1136/bjo.66.6.398.
  • Kushner BJ. Tenacious proximal fusion: the Scobee phenomenon. Am Orthopt J. 2015;65(1):73–80. doi:10.3368/aoj.65.1.73.
  • Schor CM. The influence of rapid prism adaptation upon fixation disparity. Vision Res. 1979;19(7):757–765. doi:10.1016/0042-6989(79)90151-2.
  • Niederecker O, Scott WE. The value of diagnostic occlusion for intermittent exotropia. Am Orthopt J. 1975;25:901.
  • Gürlü VP, Erda N. Diagnostic occlusion test in intermittent exotropia. J AAPOS. 2008;12(5):504–506. doi:10.1016/j.jaapos.2008.02.013.
  • Ron A, Merin S. The use of the pre-op Prism Adaptation Test (PAT) in the surgery of exotropia. Am Orthopt J. 1988;38(1):107–110. doi:10.1080/0065955X.1988.11981778.
  • Dadeya S, Kamlesh, Naniwal S. Usefulness of the preoperative prism adaptation test in patients with intermittent exotropia. J Pediatr Ophthalmol Strabismus. 2003;40(2):85–89. doi:10.3928/0191-3913-20030301-07.
  • Hatt, S. R., Leske, D. A., Liebermann, L., Mohney, B. G., Holmes, J. M. Variability of angle of deviation measurements in children with intermittent exotropia. J Am Assoc Pediatr Ophthalmol and Strabismus. 2012;16(2):120–124.
  • Johns HA, Manny RE, Fern K, Hu Y-S. The intraexaminer and interexaminer repeatability of the alternate cover test using different prism neutralization endpoints. Optom Vis Sci. 2004;81:939–946.
  • Anderson HA, Manny RE, Cotter SA, Mitchell GL, Irani JA. Effect of examiner experience and technique on the alternate cover test. Optom Vis Sci. 2010;87(3):168–175. doi:10.1097/OPX.0b013e3181d1d954.
  • Rainey BB, Schroeder TL, Goss DA, Grosvenor TP. Reliability of and comparisons among three variations of the alternating cover test. Ophthalmic Physiol Opt. 1998;18(5):430–437. doi:10.1046/j.1475-1313.1998.00375.x.
  • Pediatric Eye Disease Investigator Group PEDIG. Interobserver reliability of the prism and alternate cover test in children with esotropia. Arch Ophthalmol. 2009;127(1):59. doi:10.1001/archophthalmol.2008.548.
  • Holmes JM, Leske DA, Hohberger GG. Defining real change in prism-cover test measurements. Am J Ophthalmol. 2008;145(2):381–385. doi:10.1016/j.ajo.2007.09.012.
  • Kim WJ, Kim MM. Variability of preoperative measurements in intermittent exotropia and its effect on surgical outcome. J Am Assoc Pediatr Ophthalmol Strabismus. 2017;21(3):210–214. doi:10.1016/j.jaapos.2017.05.006.
  • Hatt SR, Leske DA, Liebermann L, Holmes JM. Quantifying variability in the measurement of control in intermittent exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2015;19(1):33–37. doi:10.1016/j.jaapos.2014.10.017.
  • Mohney BG, Holmes JM. An office-based scale for assessing control in intermittent exotropia. Strabismus. 2006;14(3):147–150. doi:10.1080/09273970600894716.
  • Kim H, Kim DH, Ahn H, Lim HT. Proposing a new scoring system in intermittent exotropia: towards a better assessment of control. Can J Ophthalmol. 2017;52(3):235–239. doi:10.1016/j.jcjo.2016.08.017.
  • Buck D, Hatt SR, Haggerty H, et al. The use of the Newcastle Control Score in the management of intermittent exotropia. Br J Ophthalmol. 2007;91(2):215–218. doi:10.1136/bjo.2006.097790.
  • Buck D, Clarke MP, Haggerty H, et al. Grading the severity of intermittent distance exotropia: the revised Newcastle Control Score. Br J Ophthalmol. 2008;92(4):577. doi:10.1136/bjo.2007.120287.
  • Haggerty H. The Newcastle Control Score: a new method of grading the severity of intermittent distance exotropia. Br J Ophthalmol. 2004;88(2):233–235. doi:10.1136/bjo.2003.027615.
  • Petrunak JL, Rao R. The evaluation of office control in intermittent exotropia: a systematic approach. Am Orthopt J. 2003;53(1):98–104. doi:10.3368/aoj.53.1.98.
  • Donahue SP, Chandler DL, Holmes JM, et al. A randomized trial comparing bilateral lateral rectus recession versus unilateral recess and resect for basic-type intermittent exotropia. Ophthalmology. 2019;126(2):305–317. doi:10.1016/j.ophtha.2018.08.034.
  • Chen AM, Holmes JM, Chandler DL, et al. A randomized trial evaluating short-term effectiveness of overminus lenses in children 3 to 6 years of age with intermittent exotropia. Ophthalmology. 2016;123(10):2127–2136. doi:10.1016/j.ophtha.2016.06.042.
  • Mohney BG, Cotter SA, Chandler DL, et al. A randomized trial comparing part-time patching with observation for intermittent exotropia in children 12 to 35 months of age. Ophthalmology. 2015;122(8):1718–1725. doi:10.1016/j.ophtha.2015.04.025.
  • Cotter SA, Mohney BG, Chandler DL, et al. A randomized trial comparing part-time patching with observation for children 3 to 10 years of age with intermittent exotropia. Ophthalmology. 2014;121(12):2299–2310. doi:10.1016/j.ophtha.2014.07.021.
  • Watts P, Tippings E, Al-Madfai H. Intermittent exotropia, overcorrecting minus lenses, and the Newcastle scoring system. J AAPOS. 2005;9(5):460–464. doi:10.1016/j.jaapos.2005.04.010.
  • Ma MML, Kang Y, Scheiman M, Chen X. Office-based vergence and accommodative therapy for the treatment of intermittent exotropia: a pilot study. Optom Vis Sci. 2019;96(12):925–933. doi:10.1097/OPX.0000000000001454.
  • Hatt SR, Mohney BG, Leske DA, Holmes JM. Variability of control in intermittent exotropia. Ophthalmology. 2008;115(2):371–376.e2. doi:10.1016/j.ophtha.2007.03.084.
  • Holmes JM, Birch EE, Leske DA, Fu VL, Mohney BG. New tests of distance stereoacuity and their role in evaluating intermittent exotropia. Ophthalmology. 2007;114(6):1215–1220. doi:10.1016/j.ophtha.2006.06.066.
  • Moon Y, Kim H, Kim DH, Lim HT. LACTOSE control scoring helps predict surgical outcomes for childhood intermittent exotropia. Can J Ophthalmol. 2019;54(6):659–663. doi:10.1016/j.jcjo.2019.02.017.
  • Fleming KJ, Cassin B. Indoor and outdoor far distance measurements in intermittent exotropia. Am Orthopt J. 1989;39(1):98–101. doi:10.1080/0065955X.1989.11981941.
  • Wang C, Wang L, Ren M, Wang Q. Far distance control scores for assessing intermittent exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2017;21(4):278–281. doi:10.1016/j.jaapos.2017.04.007.
  • Hatt SR, Leske DA, Holmes JM. Awareness of exodeviation in children with intermittent exotropia. Strabismus. 2009;17(3):101–106. doi:10.1080/09273970903107972.
  • Stella SL. The association of blinks and refusion in intermittent exotropia. Am J Optom Arch Am Acad Optom. 1968;45(7):465–471. doi:10.1097/00006324-196807000-00005.
  • Jampolsky A. Ocular divergence mechanisms. Trans Am Ophthalmol Soc. 1970;68:730–822.
  • Kushner BJ. Exotropic deviations. In: Wilson M, Saunders R, Trivedi R, eds. Pediatric Ophthalmology: Current Thought and a Practical Guide. 2009:97–111. doi:10.1007/978-3-540-68632-3_9.
  • Simmons B. Practical experience with intermittent exotropias. Am Orthopt J. 1956;6(1):80–86. doi:10.1080/0065955X.1956.11981169.
  • von Noorden G, Campos E. Binocular Vision and Ocular Motility: Theory and Management of Strabismus. 6th ed. St. Louis: Mosby; 2002:356–376.
  • Hatt SR, Liebermann L, Leske DA, Mohney BG, Holmes JM. Improved assessment of control in intermittent exotropia using multiple measures. Am J Ophthalmol. 2011;152(5):872–876. doi:10.1016/j.ajo.2011.05.007.
  • Moore S, Stockbridge L, Knapp P. A panoramic view of exotropias. Am Orthopt J. 1977;27(1):70–79. doi:10.1080/0065955X.1977.11982426.
  • Schlossman A, Muchnick RS, Stern KS. The surgical management of intermittent exotropia in adults. Ophthalmology. 1983;90(10):1166–1171. doi:10.1016/S0161-6420(83)34411-0.
  • Oh BL, Suh SY, Choung HK, Kim SJ. Squinting and photophobia in intermittent exotropia. Optom Vis Sci. 2014;91(5):533–539. doi:10.1097/OPX.0000000000000251.
  • Lew H, Kim C-H, Yun Y-S, Han S-H. Binocular photophobia after surgical treatment in intermittent exotropia. Optom Vis Sci. 2007;84(12):1101–1103. doi:10.1097/OPX.0b013e31815b9dec.
  • Song SJ, Kim MM. The photophobia incidence, stereopsis and suppression in intermittent exotropia. J Korean Ophthalmol Soc. 2000;41:2254–2257.
  • Oh S, Huh D, Hwang J, Min B. The clinical characteristics of intermittent exotropia and their relationship. J Korean Ophthalmol Soc. 1998;39:2797–2802.
  • Chung SA, Rhiu S, Han SH, Lee JB. Photophobia measurement in intermittent exotropia using the contrast sensitivity test. Graefe’s Archive For Clinical And Experimental Ophthalmology. 2013;251(5):1405–1411. doi:10.1007/s00417-012-2241-z.
  • Wang FM, Chryssanthou G. Monocular eye closure in intermittent exotropia. Arch Ophthalmol. 1988;106(7):941–942. doi:10.1001/archopht.1988.01060140087030.
  • Yamada T, Hatt SR, Leske DA, Holmes JM. Specific health-related quality of life concerns in children with intermittent exotropia. Strabismus. 2012;20(4):145–151. doi:10.3109/09273972.2012.735338.
  • Campos EC, Cipolli C. Binocularity and photophobia in intermittent exotropia. Percept Mot Skills. 1992;74(3_suppl):1168–1170. doi:10.2466/pms.1992.74.3c.1168.
  • Akbari MR, Mirzajani A, Moeinitabar MR, Mirmohammadsadeghi A, Khorrami-Nejad M, Sharbatoghli L. The effect of alternate occlusion on control of intermittent exotropia in children. Eur J Ophthalmol. 2020;30(2):275–279. doi:10.1177/1120672119827764.
  • Wiggins RE, von Noorden GK. Monocular eye closure in sunlight. J Pediatr Ophthalmol Strabismus. 1990;27(1):16–20. doi:10.3928/0191-3913-19900101-05.
  • Coats DK, Paysse EA, Kim DS. Excessive blinking in childhood: a prospective evaluation of 99 children. Ophthalmology. 2001;108(9):1556–1561. doi:10.1016/S0161-6420(01)00644-3.
  • Ginsborg BL, Maurice DM. Involuntary movements of the eye during fixation and blinking. Br J Ophthalmol. 1959;43(7):435–437. doi:10.1136/bjo.43.7.435.
  • Collewijn H, van der Steen J, Steinman RM. Human eye movements associated with blinks and prolonged eyelid closure. J Neurophysiol. 1985;54(1):11–27. doi:10.1152/jn.1985.54.1.11.
  • Hirota M, Yada K, Morimoto T, et al. Objective evaluation of visual fatigue in patients with intermittent exotropia. PLoS One. 2020;15(3):1–16. doi:10.1371/journal.pone.0230788.
  • Hatt SR. Quality of life in intermittent exotropia. Arch Ophthalmol. 2008;126(11):1525–1529. doi:10.1001/archopht.126.11.1525.
  • Mojon-Azzi SM, Potnik W, Mojon DS. Opinions of dating agents about strabismic subjects’ ability to find a partner. Br J Ophthalmol. 2008;92(6):765–769. doi:10.1136/bjo.2007.128884.
  • Bez Y, Coşkun E, Erol K, et al. Adult strabismus and social phobia: a case-controlled study. J AAPOS. 2009;13(3):249–252. doi:10.1016/j.jaapos.2009.02.010.
  • Mojon-Azzi SM, Mojon DS. Strabismus and employment: the opinion of headhunters. Acta Ophthalmol. 2009;87(7):784–788. doi:10.1111/j.1755-3768.2008.01352.x.
  • Olitsky SE, Sudesh S, Graziano A, Hamblen J, Brooks SE, Shaha SH. The negative psychosocial impact of strabismus in adults. J AAPOS. 1999;3(4):209–211. doi:10.1016/S1091-8531(99)70004-2.
  • Lukman H, Kiat JE, Ganesan A, Chua WL, Khor KL, Choong YF. Negative social reaction to strabismus in school children ages 8-12 years. J AAPOS. 2011;15(3):238–240. doi:10.1016/j.jaapos.2011.01.158.
  • Mohney BG. Intermittent exotropia and mental illness. Am Orthopt J. 2016;66(1):25–29. doi:10.3368/aoj.66.1.25.
  • Guyatt GH. Measuring health-related quality of life. Ann Int Med. 1993;118(8):622. doi:10.7326/0003-4819-118-8-199304150-00009.
  • Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care. 1989;27(Supplement):S217–32. doi:10.1097/00005650-198903001-00018.
  • Chow MYK, Morrow AM, Cooper Robbins SC, Leask J. Condition-specific quality of life questionnaires for caregivers of children with pediatric conditions: a systematic review. Qual Life Res. 2013;22(8):2183–2200. doi:10.1007/s11136-012-0343-z.
  • Hatt SR, Leske DA, Holmes JM. Comparison of quality-of-life instruments in childhood intermittent exotropia. J AAPOS. 2010;14(3):221–226. doi:10.1016/j.jaapos.2010.01.011.
  • Buck D, Ali N, Tiffin P, Taylor R, Powell C, Clarke M. Child-rated and parent-rated quality of life in childhood intermittent exotropia: findings from an observational cohort study. Ophthalmol Res An Int J. 2015;3(3):59–66. doi:10.9734/OR/2015/15246.
  • Hatt SR, Leske DA, Yamada T, Bradley EA, Cole SR, Holmes JM. Development and initial validation of quality-of-life questionnaires for intermittent exotropia. Ophthalmology. 2010;117(1):163–168.e1. doi:10.1016/j.ophtha.2009.06.038.
  • Leske DA, Holmes JM, Michele Melia B, Pediatric Eye Disease Investigator Group PEDIG. Evaluation of the intermittent exotropia questionnaire using rasch analysis. JAMA Ophthalmol. 2015;133(4):461–465. doi:10.1001/jamaophthalmol.2014.5622.
  • Zhu H, Shen L, Yuan C-Q, et al. The development of the Chinese intermittent exotropia questionnaire. Optom Vis Sci. 2017;94(6):707–713. doi:10.1097/OPX.0000000000001080.
  • Hikoya A, Komori M, Suzuki H, Hotta Y, Sato M. Health-related quality of life in Japanese children with intermittent exotropia and their parents. J Am Assoc Pediatr Ophthalmol Strabismus. 2018;22(4):e21–2. doi:10.1016/j.jaapos.2018.07.072.
  • Lim SB, Wong WL, Ho RC, Wong IB. Childhood intermittent exotropia from a different angle: does severity affect quality of life? Br J Ophthalmol. 2015;99(10):1405–1411. doi:10.1136/bjophthalmol-2014-306545.
  • Wang, Y., Xu, M., Yu, H., Xu, J., Hou, F., Zhou, J., Yu, X. Health-related quality of life correlated with the clinical severity of intermittent exotropia in children. Eye. 2020;34(2):400–407.
  • Yamada T, Hatt SR, Leske DA, Holmes JM. Spectacle wear in children reduces parental health-related quality of life. J AAPOS. 2011;15(1):24–28. doi:10.1016/j.jaapos.2010.11.003.
  • Stathacopoulos RA, Rosenbaum AL, Zanoni D, et al. Distance stereoacuity. Assessing control in intermittent exotropia. Ophthalmology. 1993;100(4):495–500. doi:10.1016/S0161-6420(93)31616-7.
  • Singh A, Sharma P, Singh D, Saxena R, Sharma A, Menon V. Evaluation of FD2 (Frisby Davis distance) stereotest in surgical management of intermittent exotropia. Br J Ophthalmol. 2013;97(10):1318–1321. doi:10.1136/bjophthalmol-2012-302321.
  • Nishikawa N, Ishiko S, Yamaga I, Sato M, Yoshida A. Distance stereotesting using vision test charts for intermittent exotropia. Clin Ophthalmol. 2015;9:1557–1562. doi:10.2147/OPTH.S89727.
  • O’Connor AR, Birch EE, Anderson S, Draper H. The functional significance of stereopsis. Investig Ophthalmol Vis Sci. 2010;51(4):2019–2023. doi:10.1167/iovs.09-4434.
  • Adams WE. Frisby Davis distance stereoacuity values in visually normal children. Br J Ophthalmol. 2005;89(11):1438–1441. doi:10.1136/bjo.2005.071761.
  • Fu VLN, Birch EE, Holmes JM. Assessment of a new distance randot stereoacuity test. J Am Assoc Pediatr Ophthalmol Strabismus. 2006;10(5):419–423. doi:10.1016/j.jaapos.2006.06.013.
  • Chen AM, Erzurum SA, Chandler DL, et al. Overminus lens therapy for children 3 to 10 years of age with intermittent exotropia: a randomized clinical trial. JAMA Ophthalmol. 2021;139(4):464–476. doi:10.1001/jamaophthalmol.2021.0082.
  • Hatt SR, Mohney BG, Leske DA, Holmes JM. Variability of stereoacuity in intermittent exotropia. Am J Ophthalmol. 2008;145(3):556–561.e1. doi:10.1016/j.ajo.2007.10.028.
  • Leske DA, Birch EE, Holmes JM. Real depth vs randot stereotests. Am J Ophthalmol. 2006;142(4):699–701. doi:10.1016/j.ajo.2006.04.065.
  • Sharma P, Saxena R, Narvekar M, Gadia R, Menon V. Evaluation of distance and near stereoacuity and fusional vergence in intermittent exotropia. Indian J Ophthalmol. 2008;56(2):121. doi:10.4103/0301-4738.39116.
  • Hu C, Huang X, Liu G, Li H, Yang X, Han B. Study on the near, middle and long distance stereopsis of normal and children with intermittent exotropia. Zhonghua Yan Ke Za Zhi. 2002;38:452–456.
  • Saxena R, Kakkar A, Menon V, Sharma P, Phuljhele S. Evaluation of factors influencing distance stereoacuity on Frisby-Davis distance test (FD2) in intermittent exotropia. Br J Ophthalmol. 2011;95(8):1098–1101. doi:10.1136/bjo.2010.182139.
  • Baker JD, Davies GT. Monofixational intermittent exotropia. Arch Ophthalmol. 1979;97(1):93–95. doi:10.1001/archopht.1979.01020010033007.
  • Adams WE, Leske DA, Hatt SR, Holmes JM. Defining real change in measures of stereoacuity. Ophthalmology. 2009;116(2):281–285. doi:10.1016/j.ophtha.2008.09.012.
  • Pratt-Johnson J, Wee HS. Suppression associated with exotropia. Can J Ophthalmol. 1969;4:136–144.
  • Steinbach MJ. Alternating exotropia: temporal course of the switch in suppression. Invest Ophthalmol Vis Sci. 1981;20:129–133.
  • Jampolsky A. Characteristics of suppression in strabismus. Arch Ophthalmol. 1955;54(5):683–696. doi:10.1001/archopht.1955.00930020689010.
  • Joosse MV, Esme DL, Schimsheimer RJ, Verspeek SAM, Vermeulen MHL, van Minderhout EM. Visual evoked potentials during suppression in exotropic and esotropic strabismics: strabismic suppression objectified. Graefe’s Arch Clin Exp Ophthalmol. 2005;243(2):142–150. doi:10.1007/s00417-004-0994-8.
  • Cooper J, Record CD. Suppression and retinal correspondence in intermittent exotropia. Br J Ophthalmol. 1986;70(9):673–676. doi:10.1136/bjo.70.9.673.
  • Cooper J, Feldman J, Pasner K. Intermittent exotropia: stimulus characteristics affect tests for retinal correspondence and suppression. Binocul Vis Strabismus Q. 2000;15:131–140.
  • Serrano-Pedraza I, Manjunath V, Osunkunle O, Clarke MP, Read JCA. Visual suppression in intermittent exotropia during binocular alignment. Investig Ophthalmol Vis Sci. 2011;52(5):2352–2364. doi:10.1167/iovs.10-6144.
  • Pritchard C, Flynn JT. Suppression of physiologic diplopia in intermittent exotropia. Am Orthopt J. 1981;31(1):72–79. doi:10.1080/0065955X.1981.11982529.
  • Huang C, Wang A, Hu F, Tsai T. Exploring the divergence range for stereopsis maintenance with a computer-simulated troposcope in patients with intermittent exotropia. Invest Opthalmol Visual Sci. 2016;57(10):4493–4497. doi:10.1167/iovs.16-19779.
  • Joosse MV, Simonsz HJ, Van Minderhout EM, Mulder PGH, De Jong PTVM. Quantitative visual fields under binocular viewing conditions in primary and consecutive divergent strabismus. Graefe’s Arch Clin Exp Ophthalmol. 1999;237:535–545. doi:10.1007/s004170050276.
  • Economides JR, Adams DL, Horton JC. Perception via the deviated eye in strabismus. J Neurosci. 2012;32(30):10286–10295. doi:10.1523/JNEUROSCI.1435-12.2012.
  • Serrano-Pedraza I, Clarke MP, Read JCA. Single vision during ocular deviation in intermittent exotropia. Ophthalmic Physiol Opt. 2011;31(1):45–55. doi:10.1111/j.1475-1313.2010.00805.x.
  • Etezad Razavi M, Najaran M, Azimi A, et al. Correlation between worth four dot test results and fusional control in intermittent exotropia. J Ophthalmic Vis Res. 2012;7:134–138.
  • Pratt Johnson JA. Some clinical implications of strabismic suppression scotoma. Am Orthopt J. 1976;26(1):25–30. doi:10.1080/0065955X.1976.11982396.
  • Yildirim C, Altinsoy HI. Distance alternate-letter suppression test for objective assessment of sensorial status in intermittent exotropia. Eur J Ophthalmol. 2000;10(1):4–10. doi:10.1177/112067210001000102.
  • Ma MML, Kang Y, Scheiman M, Chen Q, Ye X, Chen X. Maintenance of normal fusion in intermittent exotropia. Ophthalmic Physiol Opt. 2021;41(1):33–41.
  • Herzau V. How useful is anomalous correspondence? Eye. 1996;10(2):266–269. doi:10.1038/eye.1996.56.
  • Flom MC, Kirschen DG, Williams AT. Changes in retinal correspondence following surgery for intermittent exotropia. Optom Vis Sci. 1978;55(7):456–462. doi:10.1097/00006324-197807000-00003.
  • Flom MC. Determination of retinal correspondence. Arch Ophthalmol. 1967;77(2):200. doi:10.1001/archopht.1967.00980020202010.
  • Morgan MW. Anomalous correspondence interpreted as a motor phenomenon. Optom Vis Sci. 1961;38(3):131–148. doi:10.1097/00006324-196103000-00001.
  • Cooper J, Feldman J. Panoramic viewing, visual acuity of the deviating eye, and anomalous retinal correspondence in the intermittent exotrope of the divergence excess type. Optom Vis Sci. 1979;56(7):422–429. doi:10.1097/00006324-197907000-00003.
  • Joosse MV. History of strabismology the visual field in strabismus: a historical review of studies on amblyopia and suppression. Strabismus. 2000;8(2):135–149. doi:10.1076/0927-3972(200006)821-2FT135.
  • Campos EC. Binocularity in comitant strabismus: binocular visual fields studies. Doc Ophthalmol. 1982;53(3):249–281. doi:10.1007/BF00140423.
  • Johnston AW. An analysis of clinical test results for anomalous correspondence. Clin Exp Optom. 1970;53(2):38–56. doi:10.1111/j.1444-0938.1970.tb00908.x.
  • Verma A. Anomalous adaptive conditions associated with strabismus. Ann Ophthalmol. 2007;39(2):95–106. doi:10.1007/s12009-007-0006-9.
  • Burian HM. Sensorial retinal relationship in concomitant strabismus. Arch Ophthalmol. 1947;37(5):618–648. doi:10.1001/archopht.1947.00890220635008.
  • Kushner BJ. Diagnosis and treatment of exotropia with a high accommodation convergence–accommodation raio. Arch Ophthalmol. 1999;117(2):221–224. doi:10.1001/archopht.117.2.221.
  • Brown HW. Accommodative convergence in exodeviation. Int Ophthalmol Clin. 1971;11(4):39–45. doi:10.1097/00004397-197101140-00007.
  • Bhoola H, Bruce AS, Atchison DA. Validity of clinical measures of the AC/A ratio. Clin Exp Optom. 1995;78(1):3–10. doi:10.1111/j.1444-0938.1995.tb00776.x.
  • Jackson JH, Arnoldi K. The gradient AC/A ratio: what’s really normal? Am Orthopt J. 2004;54(1):125–132. doi:10.3368/aoj.54.1.125.
  • Rovick LP. Accommodative and fusional convergence in intermittent exotropia. Am Orthopt J. 2016;66(1):16–24. doi:10.3368/aoj.66.1.16.
  • Arnoldi KA, Reynolds JD. Diagnosis of pseudo-divergence excess exotropia secondary to high accommodative convergence to accommodation ratio. Am Orthopt J. 2006;56(1):133–137. doi:10.3368/aoj.56.1.133.
  • Jiménez R, Pérez MA, García JA, González MD. Statistical normal values of visual parameters that characterize binocular function in children. Ophthalmic Physiol Opt. 2004;24(6):528–542. doi:10.1111/j.1475-1313.2004.00234.x.
  • Daum KM. Characteristics of exodeviations: I. A comparison of three classes. Am J Optom Physiol Opt. 1986;63(4):237–243. doi:10.1097/00006324-198604000-00001.
  • Schor C. The influence of interactions between accommodation and convergence on the lag of accommodation. Opthalmology Physiol Opt. 1999;19(2):134–150. doi:10.1046/j.1475-1313.1999.00409.x.
  • Hasebe S, Nonaka F, Ohtsuki H. Accuracy of accommodation in heterophoric patients: testing an interaction model in a large clinical sample. Ophthalmic Physiol Opt. 2005;25(6):582–591. doi:10.1111/j.1475-1313.2005.00331.x.
  • Schnider CM, Ciuffreda KJ, Cooper J, Kruger PB. Accommodation dynamics in divergence excess exotropia. Investig Ophthalmol Vis Sci. 1984;25:414–418.
  • Miyata M, Hasebe S, Ohtsuki H. Influence of accommodative lag upon the far-gradient measurement of accommodative convergence to accommodation ratio in strabismic patients. Jpn J Ophthalmol. 2006;50(5):438–442. doi:10.1007/s10384-006-0353-x.
  • Horwood AM, Riddell PM. Decreased accommodation during decompensation of distance exotropia. Br J Ophthalmol. 2012;96(4):508–513. doi:10.1136/bjophthalmol-2011-300138.
  • Somer D, Demirci S, Çınar FG, Duman S. Accommodative ability in exotropia: predictive value of surgical success. J Am Assoc Pediatr Ophthalmol Strabismus. 2007;11(5):460–464. doi:10.1016/j.jaapos.2007.01.123.
  • Yang HK, Hwang JM. Decreased accommodative response in the nondominant eye of patients with intermittent exotropia. Am J Ophthalmol. 2011;151(1):71–76.e1. doi:10.1016/j.ajo.2010.06.047.
  • Lança CC, Rowe FJ. Measurement of fusional vergence: a systematic review. Strabismus. 2019;27(2):88–113. doi:10.1080/09273972.2019.1583675.
  • Horwood AM, Riddell PM. A novel experimental method for measuring vergence and accommodation responses to the main near visual cues in typical and atypical groups. Strabismus. 2009;17(1):9–15. doi:10.1080/09273970802678602.
  • Campos EC. Sensory and sensori-motor adaptations in strabismus: their role in space perception. Acta Psychol (Amst). 1986;63(3):281–295. doi:10.1016/0001-6918(86)90048-X.
  • Hatt SR, Leske DA, Mohney BG, Brodsky MC, Holmes JM. Fusional convergence in childhood intermittent exotropia. Am J Ophthalmol. 2011;152(2):314–319. doi:10.1016/j.ajo.2011.01.042.
  • Yam JCS, Chong GSL, Wu PKW, Wong USF, Chan CWN, Ko STC. A prospective study of fusional convergence parameters in Chinese patients with intermittent exotropia. J AAPOS. 2013;17(4):347–351. doi:10.1016/j.jaapos.2013.03.023.
  • Horwood AM, Riddell PM. Evidence that convergence rather than accommodation controls intermittent distance exotropia. Acta Ophthalmol. 2012;90(2):e109–e117. doi:10.1111/j.1755-3768.2011.02313.x.
  • Sanfilippo S, Clahane AC. The effectiveness of orthoptics alone in selected cases of exodeviation: the immediate results and several years later. Am Orthopt J. 1970;20(1):104–117. doi:10.1080/0065955X.1970.11982271.
  • Cooper EL, Leyman IA. The management of intermittent exotropia: a comparison of the results of surgical and nonsurgical treatment. Am Orthopt J. 1977;27(1):61–67. doi:10.1080/0065955X.1977.11982424.
  • Goldrich SG. Optometric therapy of divergence excess strabismus. Optom Vis Sci. 1980;57(1):7–14. doi:10.1097/00006324-198001000-00002.
  • Pejic Z, Wong W, Husain R, Ling Y, Farzavandi S. Fusion exercises for treatment of intermittent exotropia and phoria. Am Orthopt J. 2006;56(1):138–146. doi:10.3368/aoj.56.1.138.
  • Wakayama A, Seki Y, Takahashi R, et al. Role of fusional convergence amplitude in postoperative phoria maintenance in children with intermittent exotropia. Jpn J Ophthalmol. 2018;62(3):307–314. doi:10.1007/s10384-018-0585-6.
  • Cooper J. Clinical implications of vergence adaptation. Optom Vis Sci. 1992;69(4):300–307. doi:10.1097/00006324-199204000-00008.
  • Rouse MW, Borsting E, Deland PN, Convergence Insufficiency and Reading Study (CIRS) Group. Reliability of binocular vision measurements used in the classification of convergence insufficiency. Optom Vis Sci. 2002;79(4):254–264. doi:10.1097/00006324-200204000-00012.
  • Ma MM, Kang Y, Scheiman M, Chen Q, Ye X, Chen X. Reliability of step vergence method for assessing fusional vergence in intermittent exotropia. Ophthalmic Physiol Opt. 2022;42(4):913–920.
  • Liebermann L, Hatt SR, Leske DA, et al. Assessing divergence in children with intermittent exotropia. Strabismus. 2012;20(1):11–16. doi:10.3109/09273972.2012.655838.
  • Fu T, Wang J, Levin M, Su Q, Li D, Li J. Fusional vergence detected by prism bar and synoptophore in Chinese childhood intermittent exotropia. J Ophthalmol. 2015;2015:1–6. doi:10.1155/2015/987048.
  • Bruce GM. Ocular divergence: its physiology and pathology. Arch Ophthalmol. 1935;13(4):639–660. doi:10.1001/archopht.1935.00840040129012.
  • Adams DL, Economides JR, Horton JC. Incomitance and eye dominance in intermittent exotropia. Investig Ophthalmol Vis Sci. 2017;58(10):4049–4055. doi:10.1167/iovs.17-22155.
  • Kekunnaya R, Mendonca T, Sachdeva V. Pattern strabismus and torsion needs special surgical attention. Eye. 2015;29(2):184–190. doi:10.1038/eye.2014.270.
  • Clark RA, Miller JM, Rosenbaum AL, Demer JL. Heterotopic muscle pulleys or oblique muscle dysfunction? J Am Assoc Pediatr Ophthalmol Strabismus. 1998;2(1):17–25. doi:10.1016/S1091-8531(98)90105-7.
  • Oh SY, Clark RA, Velez F, Rosenbaum AL, Demer JL. Incomitant strabismus associated with instability of rectus pulleys. Invest Ophthalmol Vis Sci. 2002;43:2169–2178.
  • Shin KH, Lee HJ, Lim HT. Ocular torsion among patients with intermittent exotropia: relationships with disease severity factors. Am J Ophthalmol. 2013;155(1):177–182. doi:10.1016/j.ajo.2012.07.011.
  • Kushner BJ. Effect of ocular torsion on a and V patterns and apparent oblique muscle overaction. Arch Ophthalmol. 2010;128(6):712. doi:10.1001/archophthalmol.2010.88.
  • Scott WE, Weaver RG. Chin up and chin down head positions. Am Orthopt J. 1983;33(1):24–31. doi:10.1080/0065955X.1983.11981594.
  • Moore S. The prognostic value of lateral gaze measurements in intermittent exotropia. Am Orthopt J. 1969;19(1):69–71. doi:10.1080/0065955X.1969.11981553.
  • Yoon CH, Kim SJ. Lateral incomitancy and surgical results in intermittent exotropia. Br J Ophthalmol. 2014;98(10):1404–1408. doi:10.1136/bjophthalmol-2014-305132.
  • Repka M, Arnoldi K, Wilson ME. Lateral incomitance in exotropia: fact or artifact?/lateral incomitance in exotropia: fact or artifact? discussion. J Pediatr Ophthalmol Strabismus. 1991;28(3):125–130. doi:10.3928/0191-3913-19910501-03.
  • Neikter B. Horizontal and vertical deviations after prism neutralization and diagnostic occlusion in intermittent exotropia. Strabismus. 1994;2(1):13–22. doi:10.3109/09273979409105049.
  • Choi J, Chang JW, Kim S-J, Yu YS. The long-term survival analysis of bilateral lateral rectus recession versus unilateral recession-resection for intermittent exotropia. Am J Ophthalmol. 2012;153(2):343–351.e1. doi:10.1016/j.ajo.2011.06.024.
  • Kim JY, Kim HR, Lee SJ. Characteristics of patients who are not responsive to alternate patching for overcorrected intermittent exotropia. Korean J Ophthalmol. 2018;32(4):319. doi:10.3341/kjo.2017.0086.
  • Carlson MR. Lateral incomitancy in intermittent exotropia. Arch Ophthalmol. 1979;97(10):1922. doi:10.1001/archopht.1979.01020020370019.
  • Pineles SL, Ela-Dalman N, Zvansky AG, Yu F, Rosenbaum AL. Long-term results of the surgical management of intermittent exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2010;14(4):298–304. doi:10.1016/j.jaapos.2010.06.007.
  • Pratt-Johnson JA, Tillson G. Management of the vertical associated with horizontal strabismus. Am Orthopt J. 1978;28(1):24–27. doi:10.1080/0065955X.1978.11982451.
  • Struck MC, Hariharan L, Kushner BJ, Bradfield Y, Hetzel S. Surgical management of clinically significant hypertropia associated with exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2010;14(3):216–220. doi:10.1016/j.jaapos.2010.01.016.
  • Struck MC, Daley TJ. Resolution of hypertropia with correction of intermittent exotropia. Br J Ophthalmol. 2013;97(10):1322–1324. doi:10.1136/bjophthalmol-2013-303553.
  • Marlow FW. Observations on the prolonged occlusion test. Am J Ophthalmol. 1927;10(8):567–574. doi:10.1016/S0002-9394(27)90757-0.
  • Lim HT, Smith DR, Kraft SP, Buncic JR. Dissociated vertical deviation in patients with intermittent exotropia. J Am Assoc Pediatr Ophthalmol Strabismus. 2008;12(4):390–395. doi:10.1016/j.jaapos.2007.11.019.
  • Pritchard C. Incidence of dissociated vertical divergence in intermittent exotropia. Am Orthopt J. 1998;48(1):90–93. doi:10.1080/0065955X.1998.11982164.
  • Helveston EM. Dissociated vertical deviation-a clinical and laboratory study. Trans Am Ophthalmol Soc. 1980;78:734–779.

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