Divergence excess and basic exotropia types of intermittent exotropia: a major review. Part 2: non-surgical and surgical treatment options

References

• Lavrich JB. Intermittent exotropia: continued controversies and current management. Curr Opin Ophthalmol. 2015;26(5):375–381. doi:10.1097/ICU.0000000000000188.
   PubMed Web of Science ®Google Scholar
• Gnanaraj L, Richardson SR. Interventions for intermittent distance exotropia: review. Eye. 2005;19(6):617–621. doi:10.1038/sj.eye.6701617.
   PubMed Web of Science ®Google Scholar
• Joyce KE, Beyer F, Thomson RG, Clarke MP. A systematic review of the effectiveness of treatments in altering the natural history of intermittent exotropia. British J Ophthalmol. 2015;99(4):440–450. doi:10.1136/bjophthalmol-2013-304627.
   PubMed Web of Science ®Google Scholar
• Coffey B, Wick B, Cotter S, et al. Treatment options in intermittent exotropia: a critical appraisal. Optom Vis Sci. 1992;69(5):386–404. doi:10.1097/00006324-199205000-00008.
   PubMed Web of Science ®Google Scholar
• Holmes JM, Hatt SR, Leske DA. Is intermittent exotropia a curable condition? Eye. 2015;29(2):171–176. doi:10.1038/eye.2014.268.
   PubMed Web of Science ®Google Scholar
• Hatt SR, Gnanaraj L. Interventions for intermittent exotropia. Cochrane Database Syst Rev. 2013;276:391–402. doi:10.1002/14651858.CD003737.pub3.
   Google Scholar
• Pineles SL, Ela-Dalman N, Zvansky AG, et al. Long-term results of the surgical management of intermittent exotropia. J Aapos. 2010;14(4):298–304. doi:10.1016/j.jaapos.2010.06.007.
   PubMed Web of Science ®Google Scholar
• Hunter DG, Kelly JB, Buffenn AN, Ellis FJ. Long-term outcome of uncomplicated infantile exotropia. J Aapos. 2001;5(6):352–356. doi:10.1067/mpa.2001.120175.
   PubMed Web of Science ®Google Scholar
• Baker JD. Twenty-year follow-up of surgery for intermittent exotropia. J Aapos. 2008;12(3):227–232. doi:10.1016/j.jaapos.2008.02.007.
   PubMed Web of Science ®Google Scholar
• Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG. Postoperative outcomes in children with intermittent exotropia from a population-based cohort. J Aapos. 2009;13(1):4–7. doi:10.1016/j.jaapos.2008.06.001.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Koklanis K, Georgievski Z. Recurrence of intermittent exotropia: factors associated with surgical outcomes. Strabismus. 2009;17(1):37–40. doi:10.1080/09273970802678750.
   PubMedGoogle Scholar
• Maruo T, Kubota N, Sakaue T, Usui C. Intermittent exotropia surgery in children: long term outcome regarding changes in binocular alignment. A study of 666 cases. Binocul Vis Strabismus Q. 2001;16:265–270.
   PubMedGoogle Scholar
• 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:http://dx.doi.org/10.1016/j.ophtha.2014.07.021.
   PubMed Web of Science ®Google Scholar
• Summers AI, Morrison DG, Chandler DL, et al. A Pilot randomized clinical trial of base-in relieving prism spectacle treatment of intermittent exotropia. Optom Vis Sci. 2023;100(7):432–443. doi:10.1097/OPX.0000000000002039.
   PubMed Web of Science ®Google Scholar
• 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:http://dx.doi.org/10.1016/j.ophtha.2016.06.042.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMedGoogle Scholar
• Daum KM. Divergence excess: characteristics and results of treatment with orthoptics. Ophthalmic Physiol Opt. 1984;4(1):15–24. doi:10.1111/j.1475-1313.1984.tb00327.x.
   PubMed Web of Science ®Google Scholar
• Daum KM. Equal exodeviations: characteristics and results of treatment with orthoptics. Clin Exp Optom. 1984;67(2):53–59. doi:10.1111/j.1444-0938.1984.tb02354.x.
   Google Scholar
• 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.
   PubMedGoogle Scholar
• Pejic Z, Wong W, Husain R, et al. Fusion exercises for treatment of intermittent exotropia and phoria. Am Orthopt J. 2006;56(1):138–146. doi:10.3368/aoj.56.1.138.
   PubMedGoogle Scholar
• Goldrich SG. Optometric therapy of divergence excess strabismus. Optom Vis Sci. 1980;57(1):7–14. doi:10.1097/00006324-198001000-00002.
   Google Scholar
• 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.
   PubMedGoogle Scholar
• Ma, Martin Ming-Leung, et al. Office-based vergence and anti-suppression therapy for the treatment of small-to-moderate angle intermittent exotropia: A randomised clinical trial. Ophthalmic Physiol Opt. 2023.
   Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Cooper J, Duckman R. Convergence insufficiency: incidence, diagnosis, and treatment. J Am Optom Assoc. 1978;49:67380.
   Google Scholar
• London R. Passive treatments for early onset strabismus. Probl Optometry. 1990;2:481–494.
   Google Scholar
• Piano M, O’Connor AR. Conservative management of intermittent distance exotropia: a review. Am Orthopt J. 2011;61(1):103–116. doi:10.3368/aoj.61.1.103.
   PubMedGoogle Scholar
• Iacobucci IL, Archer SM, Giles CL. Children with exotropia responsive to spectacle correction of hyperopia. Am J Ophthalmol. 1993;116(1):79–83. doi:10.1016/S0002-9394(14)71748-9.
   PubMed Web of Science ®Google Scholar
• Kushner BJ. Surgical pearls for the management of exotropia. Am Orthopt J. 1992;42(1):65–71. doi:10.1080/0065955X.1992.11981896.
   Google Scholar
• Gusek-Schneider G-C, Kulzer J, Boss A. Was bringt der Refraktionsausgleich bei Strabismus divergens intermittens und dekompensierender Exophorie? Klin Monbl Augenheilkd. 2006;223(7):620–628. doi:10.1055/s-2006-926500.
   PubMedGoogle Scholar
• Chung SA, Kim IS, Kim WK, Lee JB. Changes in exodeviation following hyperopic correction in patients with intermittent exotropia. J Pediatr Ophthalmol Strabismus. 2011;48(5):278–284. doi:10.3928/01913913-20101217-01.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMedGoogle Scholar
• Ma MM-L, Scheiman M. Divergence excess and basic exotropia types of intermittent exotropia: a major review. Part 1: prevalence, classification, risk factors, natural history and clinical characteristics. Strabismus. 2023;31(2):97–128. doi:10.1080/09273972.2023.2227681.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Holmes JM, Ch B, Holmes JM. Current nonsurgical management of intermittent exotropia current nonsurgical management of intermittent exotropia. Am Orthoptic J. 2017;66(1):42–46. doi:10.3368/aoj.66.1.42.
   Google Scholar
• Chia A, Seenyen L, Long QB. A retrospective review of 287 consecutive children in Singapore presenting with intermittent exotropia. J Aapos. 2005;9(3):257–263. doi:10.1016/j.jaapos.2005.01.007.
   PubMed Web of Science ®Google Scholar
• Wilson ME. Intermittent exotropia: when to observe and when to treat. J Aapos. 2011;15(6):518. doi:10.1016/j.jaapos.2011.10.001.
   PubMed Web of Science ®Google Scholar
• Moore S. Orthoptic treatment for intermittent exotropia. Am Orthopt J. 1964;13(1):14–20. doi:10.1080/0065955X.1964.11981409.
   Google Scholar
• Heydarian S, Hashemi H, Jafarzadehpour E, et al. Non-surgical management options of intermittent exotropia: a literature review. J Curr Ophthalmol. 2020;32(3):217. doi:10.4103/JOCO.JOCO_81_20.
   PubMed Web of Science ®Google Scholar
• Romano PE, Wilson MF. Survey of current management of intermittent exotropia in the USA and Canada. In: Campos EC, ed. Strabismus and Ocular Motility Disorders. London: Macmillan Education UK; 1990:391–396.
   Google Scholar
• Vishnoi SK, Singh V, Mehra MK. Role of occlusion in treatment of intermittent exotropia. Indian J Ophthalmol. 1987;35:207–210.
   PubMedGoogle Scholar
• Mims JL, Wood RC. The effect of preoperative alternate day patching on surgical results in intermittent exotropia: a retrospective study of 66 cases. Binocul Vis Q. 1990;5:189–195.
   Google Scholar
• Iacobucci I, Henderson JW. Occlusion in the preoperative treatment of exodeviations. Am Orthopt J. 1965;15(1):42–47. doi:10.1080/0065955X.1965.11981486.
   PubMedGoogle Scholar
• Chutter CP. Occlusion treatment of intermittent divergent strabismus. Am Orthopt J. 1977;27(1):80–84. doi:10.1080/0065955X.1977.11982427.
   PubMedGoogle Scholar
• Spoor DK, Hiles DA. Occlusion therapy for exodeviations occurring in infants and young children. Ophthalmology. 1979;86(12):2152–2157. doi:10.1016/S0161-6420(79)35295-2.
   PubMed Web of Science ®Google Scholar
• Spoor DK, Hiles DA. Occlusion therapy for exodeviations in young children - a three-year follow-up. Am Orthopt J. 1983;33(1):116–120. doi:10.1080/0065955X.1983.11981609.
   Google Scholar
• Reynolds JD, Wackerhagen M. Early onset exodeviations. Am Orthopt J. 1988;38(1):94–100. doi:10.1080/0065955X.1988.11981776.
   Google Scholar
• Freeman RS, Isenberg SJ. The use of part-time occlusion for early onset unilateral exotropia. J Pediatr Ophthalmol Strabismus. 1989;26(2):94–96. doi:10.3928/0191-3913-19890301-14.
   PubMedGoogle Scholar
• Berg PH, Isenberg SJ. Treatment of unilateral exotropia by part-time occlusion. Am Orthopt J. 1991;41(1):72–76. doi:10.1080/0065955X.1991.11981858.
   Google Scholar
• Berg PH, Lozano MJ, Isenberg SJ. Long term results of part-time occlusion for intermittent exotropia. Am Orthopt J. 1998;48(1):85–89. doi:10.1080/0065955X.1998.11982163.
   Google Scholar
• Suh Y-W, Kim S-H, Lee J-Y, Cho YA. Conversion of intermittent exotropia types subsequent to part-time occlusion therapy and its sustainability. Graefes Arch Clin Exp Ophthalmol. 2006;244(6):705–708. doi:10.1007/s00417-005-0195-0.
   PubMed Web of Science ®Google Scholar
• Lee KH, Suh YW, Cho YA. The effects of part-time occlusion therapy shortened to one or two hours in intermittent exotropia. J Korean Ophthalmol Soc. 2014;55(4):585. doi:10.3341/jkos.2014.55.4.585.
   Google Scholar
• AlKahmous LS, Al-Saleh AA. Does occlusion therapy improve control in intermittent exotropia? Saudi J Ophthalmol. 2016;30(4):240–243. doi:10.1016/j.sjopt.2016.07.004.
   PubMedGoogle Scholar
• Bang SP, Lee DC, Lee SY. Surgical outcome of intermittent exotropia with improvement in control grade subsequent to part-time preoperative occlusion therapy. J Pediatr Ophthalmol Strabismus. 2018;55(1):59–64. doi:10.3928/01913913-20170703-05.
   PubMed Web of Science ®Google Scholar
• Abdelfatah M, Mahmoud A, Salman A, Elsebaay M. A pilot randomized trial evaluating overminus spectacles versus part-time occlusion for control of intermittent exotropia among children 2–10 years of age. J Egypt Ophthalmol Soc. 2018;111(2):76. doi:10.4103/ejos.ejos_8_18.
   Google Scholar
• Akbari MR, Mirzajani A, Moeinitabar MR, et al. The effect of alternate occlusion on control of intermittent exotropia in children. Eur J Ophthalmol. 2020;30(2):275–279. doi:10.1177/1120672119827764.
   PubMed Web of Science ®Google Scholar
• Kushner BJ. Conservative management of intermittent exotropia to defer or avoid surgery. J Aapos. 2019;23(5):e256.1–e256.6. doi:10.1016/j.jaapos.2019.06.010.
   Web of Science ®Google Scholar
• Kim US, Park S, Yoo HJ, Hwang J. Psychosocial distress of part-time occlusion in children with intermittent exotropia. Graefes Arch Clin Exp Ophthalmol. 2013;251(1):315–319. doi:10.1007/s00417-012-2099-0.
   PubMed Web of Science ®Google Scholar
• Chew FLM, Gesite-de Leon BU, Quah BL. Post-operative strabismus control and motor alignment for basic intermittent exotropia. Int J Ophthalmol. 2016;9(7):1011–1015. doi:10.18240/ijo.2016.07.13.
   PubMed Web of Science ®Google Scholar
• Altizer LB. The nonsurgical treatment of exotropia. Am Orthopt J. 1972;22(1):71–76. doi:10.1080/0065955X.1972.11982301.
   PubMedGoogle Scholar
• Figueira EC, Hing S. Intermittent exotropia: comparison of treatments. Clin Exp Ophthalmol. 2006;34(3):245–251. doi:10.1111/j.1442-9071.2006.01199.x.
   PubMed Web of Science ®Google Scholar
• Searle A, Vedhara K, Norman P, et al. Compliance with eye patching in children and its psychosocial effects: a qualitative application of protection motivation theory. Psychol Health Med. 2000;5(1):43–54. doi:10.1080/135485000105990.
   Google Scholar
• Caltrider N, Jampolsky A. Overcorrecting minus lens therapy for treatment of intermittent exotropia. Ophthalmology. 1983;90(10):1160–1165. doi:10.1016/S0161-6420(83)34412-2.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Mangad S, Mohan L, Vijayalakshmi M, et al. Role of overminus therapy in intermittent exotropia. Kerala J Ophthalmol. 2018;30(1):38. doi:10.4103/kjo.kjo_7_18.
   Google Scholar
• Goodacre H. Minus overcorrection: conservative treatment of intermittent exotropia in the young child-a comparative study. Aust Orthoptic J. 1985;22:9–17.
   Google Scholar
• Rowe FJ, Noonan CP, Freeman G, DeBell J. Intervention for intermittent distance exotropia with overcorrecting minus lenses. Eye (Lond). 2009;23(2):320–325. doi:10.1038/sj.eye.6703057.
   PubMed Web of Science ®Google Scholar
• Kennedy JR. The correction of divergent strabisums with concave lenses. Am J Optom Arch Am Acad Optom. 1954;31(12):605–614. doi:10.1097/00006324-195412000-00001.
   PubMedGoogle Scholar
• Kushner BJ. Does overcorrecting minus lens therapy for intermittent exotropia cause myopia? Arch Ophthalmol. 1999;117(5):638–642. doi:10.1001/archopht.117.5.638.
   PubMedGoogle Scholar
• Kim YC, Park SW. Effect of overcorrection (-)lens on stereo-acuity and angle of deviation in intermittent exotropia. J Korean Ophthalmic Opt Soc. 2013;18(3):305–311. doi:10.14479/jkoos.2013.18.3.305.
   Google Scholar
• Koklanis K, Georgievski Z, Zhang K. The use of distance stereoacuity assessment in determining the effectiveness of minus lenses in intermittent exotropia. J Aapos. 2010;14(6):488–493. doi:10.1016/j.jaapos.2010.08.010.
   PubMed Web of Science ®Google Scholar
• Sethi S, Ismaeil N, Shaffer J, et al. Overminus spectacle correction in the management of intermittent exotropia. J Aapos. 2015;19(4):e16. doi:10.1016/j.jaapos.2015.07.031.
   PubMedGoogle Scholar
• Bayramlar H, Gurturk AY, Sari U, Karadag R. Overcorrecting minus lens therapy in patients with intermittent exotropia: should it be the first therapeutic choice? Int Ophthalmol. 2017;37(2):385–390. doi:10.1007/s10792-016-0273-9.
   PubMed Web of Science ®Google Scholar
• Rutstein RP, Marsh-Tootle W, London R. Changes in refractive error for exotropes treated with overminus lenses. Optom Vis Sci. 1989;66(8):487–491. doi:10.1097/00006324-198908000-00001.
   PubMed Web of Science ®Google Scholar
• Paula JS, Ibrahim FM, Martins MC, Bicas HE, Velasco e Cruz AA. Refractive error changes in children with intermittent exotropia under overminus lens therapy. Arq Bras Oftalmol. 2009 Nov-Dec;72(6):751–754. doi:10.1590/S0004-27492009000600002. PMID: 20098893.
   PubMed Web of Science ®Google Scholar
• Iacobucci IL, Martonyi EJ, Giles CL. Results of overminus lens therapy on postoperative exodeviations. J Pediatr Ophthalmol Strabismus. 1986;23(6):287–291. doi:10.3928/0191-3913-19861101-09.
   PubMedGoogle Scholar
• Pratt-Johnson JA, Tillson G. Prismotherapy in intermittent exotropia. A preliminary report. Can J Ophthalmol. 1979;14:243–245.
   PubMed Web of Science ®Google Scholar
• Veronneau-Troutman S, Shippman S, Clahane AC. Prisms as an orthoptic tool in the management of primary exotropia. In: Orthoptics: Past, Present, Future. New York, USA: Stratton Intercontinental Medical Book Corp.; 1976:195–201.
   Google Scholar
• Moore S, Stockbridge L. An evaluation of the use of Fresnel press on prisms in childhood strabismus. Am Orthopt J. 1975;25(1):62–66. doi:10.1080/0065955X.1975.11982369.
   PubMedGoogle Scholar
• Samy El Gendy, NM, Abdel Nabi, E. Is inverse prism therapy comparable to conventional prism therapy for improving Newcastle scores in patients with basic intermittent exotropia? Semin Ophthalmol. 2019;34(7–8):497–503. doi:10.1080/08820538.2019.1655582.
   PubMed Web of Science ®Google Scholar
• Hardesty HH. Treatment of recurrent intermittent exotropia. A preliminary report. Am J Ophthalmol. 1965;60(6):1036–1046. doi:10.1016/0002-9394(65)92809-6.
   Web of Science ®Google Scholar
• Hardesty HH. Treatment of under and overcorrected intermittent exotropia with prism glasses. Am Orthopt J. 1969;19(1):110–119. doi:10.1080/0065955X.1969.11981560.
   PubMedGoogle Scholar
• Hardesty HH. Therapeutic uses of prisms in undercorrected intermittent exotropia. Int Ophthalmol Clin. 1971;11(4):277–282. doi:10.1097/00004397-197101140-00045.
   PubMedGoogle Scholar
• Hardesty HH. Prisms in the management of intermittent exotropia. Am Orthopt J. 1972;22(1):22–30. doi:10.1080/0065955X.1972.11982291.
   PubMedGoogle Scholar
• Hardesty HH, Boynton JR, Keenan JP. Treatment of intermittent exotropia. Arch Ophthalmol. 1978;96(2):268–274. doi:10.1001/archopht.1978.03910050136006.
   PubMedGoogle Scholar
• Hardesty HH. Treatment of overcorrected intermittent exotropia. Am J Ophthalmol. 1968;66(1):80–86. doi:10.1016/0002-9394(68)91792-3.
   PubMed Web of Science ®Google Scholar
• Kim DW, Han S, Kim US, Baek S. Results of conservative management for consecutive esotropia after intermittent exotropia surgery. Eye. 2015;29(6):776–782. doi:10.1038/eye.2015.16.
   PubMed Web of Science ®Google Scholar
• Lee EK, Hwang J. Prismatic correction of consecutive esotropia in children after a unilateral recession and resection procedure. Ophthalmology. 2013;120(3):504–511. doi:10.1016/j.ophtha.2012.08.026.
   PubMed Web of Science ®Google Scholar
• Gallaway M, Vaxmonsky T, Scheiman M. Management of intermittent exotropia using a combination of vision therapy and surgery. J Am Optom Assoc. 1989;60:428–434.
   PubMedGoogle Scholar
• Sarfraz A, Ahmad A. Improvement in sensory and motor aspect of intermittent exotropia by building up fusional reserves. Ophthalmol Pak. 2015;5(4):26–30.
   Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Ma MM-L, Kang Y, Chen C, et al. Vision therapy for intermittent exotropia: a case series. J Optom. 2020;14(3):247–253.
   PubMedGoogle Scholar
• Peddle A, Han E, Steiner A. Vision therapy for basic exotropia in adults: 2 case studies. Optometry - J Am Optometric Assoc. 2011;82(8):467–474. doi:10.1016/j.optm.2010.12.013.
   PubMedGoogle Scholar
• Pickwell LD. Prevalence and management of divergence excess. Optom Vis Sci. 1979;56(2):78–81. doi:10.1097/00006324-197902000-00003.
   Google Scholar
• Ziegler D, Huff D, Rouse MW. Success in strabismus therapy: a literature review. J Am Optom Assoc. 1982;53:979–983.
   PubMedGoogle Scholar
• Newman J, Mazow ML. Intermittent exotropia: is surgery necessary? Ophthalmic Surg Lasers Imaging. 1981;12(3):199–202. doi:10.3928/1542-8877-19810301-10.
   Google Scholar
• Etting GL. Strabismus therapy in private practice: cure rates after three months of therapy. J Am Optom Assoc. 1978;49:1367–1373.
   PubMedGoogle Scholar
• Asadi R, Ghasemi-Falavarjani K, Sadighi N. Orthoptic treatment in the management of intermittent exotropia. Iran J Ophtalmol. 2009;21(1):35–40.
   Google Scholar
• Flom MC. The prognosis in strabismus. Optom Vis Sci. 1958;35(10):509–514. doi:10.1097/00006324-195810000-00002.
   Google Scholar
• Berens C, Hardy LGH, Stark E. Divergence excess. Its frequency; its correlation with refraction; and the value of orthoptic treatment. Am J Ophthalmol. 1929;12(10):793–801. doi:10.1016/S0002-9394(29)91339-8.
   Google Scholar
• Ludlam WM. Orthoptic treatment of strabismus. A study of one hundred forty nine non-operated, unselected, concomitant strabismus patients completing orthoptic training at the Optometric Center of New York. Am J Optom Arch Am Acad Optom. 1961;38(7):369–388. doi:10.1097/00006324-196107000-00002.
   PubMedGoogle Scholar
• Chryssanthou G. Orthoptic management of intermittent exotropia. Am Orthopt J. 1974;24(1):69–72. doi:10.1080/0065955X.1974.11982349.
   PubMedGoogle Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Cooper J. Clinical implications of vergence adaptation. Optom Vis Sci. 1992;69(4):300–307. Available at. doi:10.1097/00006324-199204000-00008.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Singh V, Roy S, Sinha S. Role of orthoptic treatment in the management of intermittent exotropia. Indian J Ophthalmol. 1992;40:83–85.
   PubMedGoogle Scholar
• Xu M, Peng Y, Zheng F, et al. The effects of orthoptic therapy on the surgical outcome in children with intermittent exotropia: randomised controlled clinical trial. J Clin Med. 2023;12(4):1283. doi:10.3390/jcm12041283.
   PubMed Web of Science ®Google Scholar
• Matsumoto F, Wakayama A, Nakada K, et al. Long-term effects of orthoptic treatment on patients with intermittent exotropia. Invest Ophthalmol Vis Sci. 2011;52:6376.
   Google Scholar
• Frantz KA. The importance of multiple treatment modalities in a case of divergence excess. J Am Optom Assoc. 1990;61:457–462.
   PubMedGoogle Scholar
• Lyle TK. Value of orthoptics in pre-and post-surgical management of strabismus. Doc Ophthalmol. 1973;34(1):271–283. doi:10.1007/BF00151814.
   PubMedGoogle Scholar
• Garriott RS, Heyman CL, Rouse MW. Role of Optometric vision therapy for surgically treated strabismus patients. Optom Vis Sci. 1997;74(4):179–184. doi:10.1097/00006324-199704000-00018.
   PubMed Web of Science ®Google Scholar
• Dhungel P. Outcome of strabismus surgery and vision therapy in a case of intermittent exotropia. Adv Ophthalmol Vis Syst. 2015;2(1). doi:10.15406/aovs.2015.02.00031.
   Google Scholar
• France LW. The role of orthoptic therapy in exodeviations: a basis for orthoptic referral. Am Orthopt J. 1992;42(1):52–64. doi:10.1080/0065955X.1992.11981895.
   Google Scholar
• Walsh FI. Orthoptic treatment of intermittent exotropia. Am Orthopt J. 1963;13(1):73–79. doi:10.1080/0065955X.1964.11981418.
   PubMedGoogle Scholar
• Wick B. Vision therapy for very young children. Probl Optometry. 1990;2:354–364.
   Google Scholar
• Cooper J, Medow N. Major review: intermittent exotropia basic and divergence excess type. Binocul Vis Eye Muscle Surg Q. 1993;8:185–216.
   Google Scholar
• Cooper J. Intermittent exotropia of the divergence excess type. J Behav Optom. 1996;7:67–72.
   Google Scholar
• Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. 2008;126(10):1336–1349. doi:10.1001/archopht.126.10.1336.
   PubMedGoogle Scholar
• Scheiman M, Mitchell GL, Cotter S, et al. A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. Optom Vis Sci. 2005;82(7):E583–E595. doi:10.1097/01.opx.0000171331.36871.2f.
   PubMed Web of Science ®Google Scholar
• Scheiman M, Kulp MT, Cotter SA, Lawrenson JG, Wang L, Li T. Interventions for convergence insufficiency: a network meta-analysis. Cochrane Database Syst Rev. 2020;2020(12). doi:10.1002/14651858.CD006768.pub3.
   Google Scholar
• Tibbs A. Orthoptic treatment of constant and intermittent exotropia. Am Orthopt J. 1978;28(1):117–123. doi:10.1080/0065955X.1978.11982469.
   PubMedGoogle Scholar
• Mcphail A. Intermittent exotropia; orthoptic treatment. Am Orthopt J. 1952;2(1):22–24. doi:10.1080/0065955X.1952.11981058.
   PubMedGoogle Scholar
• Rutstein RP, Cogen MS, Cotter SA, et al. Optometric clinical practice guideline care of the patient with strabismus: esotropia and exotropia. American Optometric Association; 2011. https://www.aoa.org/AOA/Documents/Practice%20Management/Clinical%20Guidelines/Consensus-based%20guidelines/Care%20of%20Patient%20with%20Strabismus%20Esotropia%20and%20Exotropia.pdf.
   Google Scholar
• Caloroso EE. A sequential strategy for achieving functional binocularity in strabismus. J Am Optom Assoc. 1988;59:378–387.
   PubMedGoogle Scholar
• Flax N. The optometric training of intermittent divergent strabismus. Eastern Seaboard Vision Training Conference; 1963; Washington DC, Transcript by Caryl Croisant, Morro Bay, CA.
   Google Scholar
• Flax N. Management of divergence excess intermittent exotropia. J Behav Optom. 1996;7:66–73.
   Google Scholar
• Flax N. New concepts on the control of binocular deviations. J Am Optom Assoc. 1963;34:451–454.
   Google Scholar
• Feldman J, Cooper J, Eichler R. Effect of various stimulus parameters on fusional horizontal amplitudes in normal humans. Binocul Vis Eye Muscle Surg Q. 1993;8:23–32.
   Google Scholar
• Brock F. A chronicle of orthoptic history covering 25 years of practice. Opt Wkly. 1966;33:31–35.
   Google Scholar
• Caloroso E, Rouse M. Clinical Management of Strabismus. Oxford, UK: Butterowrth-Heinemann; 1993.
   Google Scholar
• Scheiman M, Wick B. Clinical Management of Binocular Vision: Heterophoric, Accommodative and Eye Movement Disorders. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2014.
   Google Scholar
• Luke NE. Antisuppression techniques in exodeviations. Am Orthopt J. 1970;20(1):100–103. doi:10.1080/0065955X.1970.11982270.
   PubMedGoogle Scholar
• Goldrich SG. Oculomotor biofeedback therapy for exotropia. Optom Vis Sci. 1982;59(4):306–317. doi:10.1097/00006324-198204000-00004.
   Google Scholar
• Fortenbacher DL, Bartolini A, Dornbos B, Tran T. Vision therapy and virtual reality applications. Adv Ophthalmol Optom. 2018;3(1):39–59. doi:10.1016/j.yaoo.2018.04.002.
   Google Scholar
• Hussey E. Very rapid alternate occlusion as a treatment for suppression in intermittent exotropia. J Optom Vis Dev. 1995;26:18–22.
   Google Scholar
• Berens C, Elliot AJ, Sobacke L. Orthoptic training and the surgical correction of strabismus. Am J Ophthalmol. 1941;24(12):1418–1422. doi:10.1016/S0002-9394(14)77453-7.
   Google Scholar
• Qiu H, Li XY, Li HY, et al. Binocular vision training after intermittent exotropia surgery. Int Eye Sci. 2010;10:1522–1523.
   Google Scholar
• Heffernan M. Preoperative treatment in intermittent exotropia. Am Orthopt J. 1962;12(1):58–59. doi:10.1080/0065955X.1962.11981379.
   PubMedGoogle Scholar
• Repka MX. Evidence basis for surgical correction of intermittent exotropia. Am Orthopt J. 2016;66(1):47–52. doi:10.3368/aoj.66.1.47.
   Google Scholar
• Sun Y, Zhang T, Chen J. Bilateral lateral rectus recession versus unilateral recession resection for basic intermittent exotropia: a meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2018;256(3):451–458. doi:10.1007/s00417-018-3912-1.
   PubMed Web of Science ®Google Scholar
• Chougule P, Kekunnaya R. Surgical management of intermittent exotropia: do we have an answer for all? BMJ Open Ophthalmol. 2019;4(1):4. doi:10.1136/bmjophth-2018-000243.
   Web of Science ®Google Scholar
• Chia A, Seenyen L, Long QB. Surgical experiences with two-muscle surgery for the treatment of intermittent exotropia. J Aapos. 2006;10(3):206–211. doi:10.1016/j.jaapos.2005.11.015.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Buck D, Powell CJ, Sloper JJ, et al. Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study. Br J Ophthalmol. 2012;96(10):1291–1295. doi:10.1136/bjophthalmol-2012-301981.
   PubMed Web of Science ®Google Scholar
• Lucas E, Bentley CR, Aclimandos WA. The effect of surgery on the AC/A ratio. Eye. 1994;8(1):109–114. doi:10.1038/eye.1994.21.
   PubMedGoogle Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Wang X, Gao X, Xiao M, et al. Effectiveness of strabismus surgery on the health-related quality of life assessment of children with intermittent exotropia and their parents: a randomized clinical trial. J Aapos. 2015;19(4):298–303. doi:10.1016/j.jaapos.2015.04.007.
   PubMed Web of Science ®Google Scholar
• 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.
   Google Scholar
• Feng X, Zhang X, Jia Y. Improvement in fusion and stereopsis following surgery for intermittent exotropia. J Pediatr Ophthalmol Strabismus. 2015;52(1):52–57. doi:10.3928/01913913-20141230-08.
   PubMed Web of Science ®Google Scholar
• Yildirim C, Mehmet Mutlu F, Chen Y, Altinsoy HI. Assessment of central and peripheral fusion and near and distance stereoacuity in intermittent exotropic patients before and after strabismus surgery. Am J Ophthalmol. 1999;128(2):222–230. doi:10.1016/S0002-9394(99)00079-3.
   PubMed Web of Science ®Google Scholar
• Adams WE, Leske DA, Hatt SR, et al. Improvement in distance stereoacuity following surgery for intermittent exotropia. J Aapos. 2008;12(2):141–144. doi:10.1016/j.jaapos.2007.09.015.
   PubMed Web of Science ®Google Scholar
• Menon V, Singla MA, Saxena R, Phulijele S. Comparative study of unilateral and bilateral surgery in moderate exotropia. J Pediatr Ophthalmol Strabismus. 2010;47(5):288–291. doi:10.3928/01913913-20091118-07.
   PubMed Web of Science ®Google Scholar
• Kim HJ, Kim D, Choi DG. Long-term outcomes of unilateral lateral rectus recession versus recess-resect for intermittent exotropia of 20-25 prism diopters. BMC Ophthalmol. 2014;14(1):46. doi:10.1186/1471-2415-14-46.
   PubMedGoogle Scholar
• Kushner BJ. The benefits, risks, and efficacy of strabismus surgery in adults. Optom Vis Sci. 2014;91(5):e102–e109. doi:10.1097/OPX.0000000000000248.
   PubMed Web of Science ®Google Scholar
• Spencer RF, Tucker MG, Choi RY, McNeer KW. Botulinum toxin management of childhood intermittent exotropia. Ophthalmology. 1997;104(11):1762–1767. doi:10.1016/S0161-6420(97)30029-3.
   PubMed Web of Science ®Google Scholar
• Dawson ELM, Marshman WE, Lee JP. Role of botulinum toxin A in surgically overcorrected exotropia. J Aapos. 1999;3(5):269–271. doi:10.1016/S1091-8531(99)70021-2.
   PubMed Web of Science ®Google Scholar
• Lim SH, Hwang BS, Kim MM. Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia. Eye. 2012;26(6):846–852. doi:10.1038/eye.2012.55.
   PubMed Web of Science ®Google Scholar
• von Noorden G, Campos E. Binocular Vision and Ocular Motility: Theory and Management of Strabismus. 6th ed. St. Louis: Mosby; 2002:356–376.
   Google Scholar
• Oh JY, Hwang J-M. Survival analysis of 365 patients with exotropia after surgery. Eye. 2006;20(11):1268–1272. doi:10.1038/sj.eye.6702091.
   PubMed Web of Science ®Google Scholar
• Jeon H, Jung J, Choi H. Long-term surgical outcomes of early surgery for intermittent exotropia in children less than 4 years of age. Curr Eye Res. 2017;42(11):1435–1439. doi:10.1080/02713683.2017.1337154.
   PubMed Web of Science ®Google Scholar
• Yang M, Chen J, Shen T, et al. Clinical characteristics and surgical outcomes in patients with intermittent exotropia. Medicine. 2016;95(5):e2590. doi:10.1097/MD.0000000000002590.
   PubMed Web of Science ®Google Scholar
• 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.
   Google Scholar
• Hellerstein L, Dowis R, Maples W. Optometric management of strabismus patients. J Am Optom Assoc. 1994;65:621–625.
   PubMedGoogle Scholar
• 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.
   PubMedGoogle Scholar
• Hatt SR, Leske DA, Liebermann L, et al. Associations between health-related quality of life and the decision to perform surgery for childhood intermittent exotropia. Ophthalmology. 2014;121(4):883–888. doi:10.1016/j.ophtha.2013.10.029.
   PubMed Web of Science ®Google Scholar
• Ruttum MS. Initial versus subsequent postoperative motor alignment in intermittent exotropia. J Aapos. 1997;1(2):88–91. doi:10.1016/S1091-8531(97)90004-5.
   PubMedGoogle Scholar
• Park KH, Kim SY. Clinical characteristics of patients that experience different rates of exodrift after strabismus surgery for intermittent exotropia and the effect of the rate of exodrift on final ocular alignment. J Aapos. 2013;17(1):54–58. doi:10.1016/j.jaapos.2012.10.014.
   PubMed Web of Science ®Google Scholar
• Kim HJ, Choi DG. Clinical analysis of childhood intermittent exotropia with surgical success at postoperative 2 years. Acta Ophthalmol. 2016;94(2):85–89. doi:10.1111/aos.12849.
   Web of Science ®Google Scholar
• Lee J-Y, Lee G-I, Park K-A, Oh SY. Long-term evaluation of two reoperation groups for intermittent exotropia. J Aapos. 2017;21(5):349–353. doi:10.1016/j.jaapos.2017.05.031.
   PubMed Web of Science ®Google Scholar
• Ing M, Nishimura J, Okino L. Outcome study of bilateral lateral rectus recession for intermittent exotropia in children. Ophthalmic Surg Lasers Imaging. 1999;30(2):110–117. doi:10.3928/1542-8877-19990201-07.
   Google Scholar
• Richard JM, Parks MM. Intermittent exotropia: surgical results in different age groups. Ophthalmology. 1983;90(10):1172–1177. doi:10.1016/S0161-6420(83)34410-9.
   PubMed Web of Science ®Google Scholar
• Repka MX, Chandler DL, Holmes JM, et al. The relationship of age and other baseline factors to outcome of initial surgery for intermittent exotropia. Am J Ophthalmol. 2020;212:153–161. doi:10.1016/j.ajo.2019.12.008.
   PubMed Web of Science ®Google Scholar
• Pratt-Johnson JA, Barlow JM, Tillson G. Early surgery in intermittent exotropia. Am J Ophthalmol. 1977;84(5):689–694. doi:10.1016/0002-9394(77)90385-3.
   PubMed Web of Science ®Google Scholar
• Abroms AD, Mohney BG, Rush DP, et al. 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.
   PubMed Web of Science ®Google Scholar
• Zou D, Casafina C, Whiteman A, Jain S. Predictors of surgical success in patients with intermittent exotropia. J Aapos. 2017;21(1):15–18. doi:10.1016/j.jaapos.2016.11.018.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• 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.
   PubMed Web of Science ®Google Scholar
• Binion WW. The surgical treatment of intermittent exotropia. Am J Ophthalmol. 1966;61(5):869–874. doi:10.1016/0002-9394(66)90927-5.
   PubMedGoogle Scholar
• 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.
   PubMedGoogle Scholar
• Burian HM, Spivey BE. The surgical management of exodeviations. Trans Am Ophthalmol Soc. 1964;62:276–306.
   PubMedGoogle Scholar
• Burian HM. Exodeviations: their classification, diagnosis and treatment. Am J Ophthalmol. 1966;62(6):1161–1166. doi:10.1016/0002-9394(66)92570-0.
   PubMed Web of Science ®Google Scholar
• Kushner BJ. Selective surgery for intermittent exotropia based on distance/near differences. Arch Ophthalmol. 1998;116(3):324–328. doi:10.1001/archopht.116.3.324.
   PubMedGoogle Scholar
• Kamlesh BS, Goel Y, Chaudhary RB, Rastogi A, Agarwal R, Dhiman S, et al. Comparison of adjustable sutures versus nonadjustable sutures in intermittent exotropia. Eur J Ophthalmol. 2018;28(3):264–267. doi:10.5301/ejo.5001063.
   PubMed Web of Science ®Google Scholar
• Tibrewal S, Nishtha S, Bhuiyan MI, Ganesh S. Factors affecting residual exotropia after two muscle surgery for intermittent exotropia. Int J Ophthalmol. 2017;10(7):1120–1125. doi:10.18240/ijo.2017.07.16.
   PubMed Web of Science ®Google Scholar
• Choi J, Kim S-J, Yu YS. Initial postoperative deviation as a predictor of long-term outcome after surgery for intermittent exotropia. J Aapos. 2011;15(3):224–229. doi:10.1016/j.jaapos.2010.12.019.
   PubMed Web of Science ®Google Scholar
• Jang JH, Park JM, Lee SJ. Factors predisposing to consecutive esotropia after surgery to correct intermittent exotropia. Graefes Arch Clin Exp Ophthalmol. 2012;250(10):1485–1490. doi:10.1007/s00417-012-1991-y.
   PubMed Web of Science ®Google Scholar
• Kim HJ, Choi DG. Consecutive esotropia after surgery for intermittent exotropia: the clinical course and factors associated with the onset. British J Ophthalmol. 2014;98(7):871–875. doi:10.1136/bjophthalmol-2013-304726.
   PubMed Web of Science ®Google Scholar
• Pineles SL, Deitz LW, Velez FG. Postoperative outcomes of patients initially overcorrected for intermittent exotropia. J Aapos. 2011;15(6):527–531. doi:10.1016/j.jaapos.2011.08.007.
   PubMed Web of Science ®Google Scholar
• Simon JW. Complications of strabismus surgery. Curr Opin Ophthalmol. 2010;21(5):361–366. doi:10.1097/ICU.0b013e32833b7a3f.
   PubMed Web of Science ®Google Scholar
• Chand Meena M, Panchal K, Rani M. Sudden death in strabismus surgery under local anaesthesia: a case report. J Emerg Pract Trauma. 2015;3(1):34–37. doi:10.15171/jept.2017.13.
   Google Scholar
• Cooper J, Medow N, Dibble C. Mortality rate in strabismus surgery. J Am Optom Assoc. 1982;53:391–395.
   PubMedGoogle Scholar