J Korean Ophthalmol Soc.  2010 Dec;51(12):1620-1624.

Changes of Deviation After the Patch and +3.00 Diopter Spherical Lens Test in Basic Intermittent Exotropia

• Jin HC
• Park JH
• Lee SY

Abstract

PURPOSE
To assess the change of deviation angle after the patch test and +3.00 diopter (D) spherical lens test in basic intermittent exotropia.
METHODS
The present study included 57 patients diagnosed with basic intermittent exotropia. The deviation angles at near and far before and after monocular occlusion of 40 minutes or more were measured. Afterward, change of deviation was also measured by placing +3.00 D spherical lenses at near.
RESULTS
Results from the study revealed pre-occlusion mean deviation angles of 23.1 +/- 7.41 prism diopters (PD) at near, and 23.9 +/- 6.56 PD at far. After the patch test, the mean deviation angles were increased to 28.3 +/- 6.50 PD (p < 0.0001) at near, and 25.5 +/- 6.40 PD (p < 0.0001) at far. After the +3.00 D spherical lens test, the angle was increased to 31.5 +/- 7.53 PD (p < 0.0001) at near. Using the gradient method, the average accommodation convergence - accommodation ratio was 1.4 +/- 1.19 PD/D.
CONCLUSIONS
Both the patch test and +3.00 D spherical lens test significantly increased the deviation angles at near and far, they helped to find the maximum deviation angle in patients with basic intermittent exotropia.

Keyword

Basic intermittent exotropia; Monocular occlusion; +3.00 diopter spherical lens test

MeSH Terms

Exotropia
Humans
Patch Tests

Reference

References

1. Von Noorden GK. Binocular Vision and Ocular Motility. Theory and Management of Strabismus. 6th ed.St Louis: CV Mosby;2002. chap. 17.

2. Hardesty HH, Boynton JR, Keenan JP. Treatment of intermittent exotropia. Arch Ophthalmol. 1978; 96:268–74.

3. Parks MM. Ocular Motility and Strabismus. Hagerstown, Md: Harper & Row;1975. p. 113–22.

4. Burian HM, Spivey BE. The surgical management of exodeviations. Am J Ophthalmol. 1965; 59:603–20.

5. Fletcher MC, Silverman SJ. Strabismus parts. A summary of 1110 consecutive cases. Am J Ophthalmol. 1966; 61:86–94.

6. Marlowe FW. Prolonged occlusion as a test for muscle balance. Am J Ophthalmol. 1921; 4:238–50.

7. Kushner BJ, Morton GV. Diagnostic occlusion in strabismus management. J Ocul Ther Surg. 1983; 2:194–200.

8. Kushner BJ. Diagnosis and treatment of exotropia with a high accommodation convergence-accommodation ratio. Arch Ophthalmol. 1999; 117:221–4.

9. Kim SH, Kim SY, Kwon J-Y. Change of deviation angle after monocular occlusion in intermittent exotropia. J Korean Ophthalmol Soc. 2005; 46:1175–82.

10. Jang SY, Lee J-Y, Park SH, Kim SY. The meaning of monocular occlusion on preoperative evaluation in basic intermittent exotropia. J Korean Ophthalmol Soc. 2009; 50:1371–6.

11. Jung YG, Kim SH, Cho YA. The changes of exodeviation according to distance and after patching of deviated eye for 1 hour in intermittent exotropia. J Korean Ophthalmol Soc. 2004; 45:1128–33.

12. Arnoldi KA, Reynolds JD. Assessment of amplitude and control of the distance deviation in intermittent exotropia. J Pediatr Ophthalmol Strabismus. 2008; 45:150–3.

13. Scobee RG. The Oculorotary Muscles. 2nd ed.St Louis: aberrations Book;1952.

14. Kushner BJ, Morton GV. Distance/near differences in intermittent exotropia. Arch Ophthalmol. 1998; 116:478–86.

15. Kushner BJ. The distance angle to target in surgery for intermittent exotropia. Arch Ophthalmol. 1998; 116:189–94.

16. Kushner BJ. Exotropic deviations: a functional classification and approach to treatment. Am Orthopt J. 1988; 38:81–93.

17. Cooper EL. Purposeful overcorrection in exotropia. In: Kanger S. Giessen, eds.International strabismus symposium. 1966. 311–8.

18. Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981; 99:1814–8.

19. Wright KW, Spiegel PH. Exotropia. In Pediatric Ophthalmology and Strabismus. 2nd ed.New York: Springer;2003. chap. 14.