First-finder-related Clinical Features of Intermittent Exotropia

Abstract

Purpose: To determine whether the clinical features of intermittent exotropia (IXT) needing muscle surgery were different in the ophthalmologist-detected and non-specialist-detected groups (including parents). Methods: Medical records of 218 children (mean age: 5.9 ± 1.4 years) with IXT of ≥ 20 prism diopters (PD) were reviewed retrospectively. The angles of deviation were measured using the prism and alternate cover test and assessed by two ophthalmologists using photographs with a translucent occluder (photographic angle). The IXT subtype, fusional control, stereopsis, suppression, and spherical equivalent (SE) were compared between the ophthalmologist-detected and non-specialist-detected groups. Results: Mean 25.8 ± 6.8 PD of distant angle of IXT was first detected by the ophthalmologist in 41 patients (18.8%) and the non-specialists in 177 patients (81.2%). The deviated eye was more myopic in the ophthalmologist-detected than non-specialist-detected group (-0.77 ± 1.59 diopters [D] vs. -0.19 ± 1.48 D, p = 0.03). There were no other differences between the two groups. A comparison of 39 age- and non-dominant eye SE-matched pairs demonstrated that the measured angles for distant and near fixation were smaller in the ophthalmologist-detected than non-specialist-detected group (24.0 ± 6.8 PD vs. 28.5 ± 6.4 PD and 26.9 ± 6.6 PD vs. 31.0 ± 6.4 PD, respectively, p < 0.01), while the remaining characteristics, including the photographic angle, were similar. Conclusions: In cases with small angles of deviation or myopia, IXT with angles requiring surgical correction were commonly first detected by ophthalmologists during examinations. ©2022 The Korean Ophthalmological Society.

목적: 수술이 필요한 정도의 간헐외사시를 처음 발견한 사람이 안과의사인 군과 부모를 비롯한 비전문가인 군에서 간헐외사시 특징이 다른지 알아보고자 하였다. <br>대상과 방법: 평균 5.9 ± 1.4세에 20프리즘디옵터(prism diopters, PD) 이상의 간헐외사시로 진단받은 환아 218명의 의무기록을 후향적으로 조사하였다. 간헐외사시 최초 발견자가 안과의사인 군과 비전문가인 군으로 나누어, 프리즘교대가림검사로 측정한 실제사시각과 반투명가리개로 가리고 촬영한 사진을 바탕으로 전문의 2명이 평가한 사진사시각, 간헐외사시 분류, 융합조절, 입체시, 억제, 구면렌즈대응치를 비교하였다. <br>결과: 평균 원거리사시각이 25.8 ± 6.8 PD인 간헐외사시를 41명(18.8%)은 안과의사가, 177명(81.2%)은 비전문가가 처음 발견하였다. 사시안의 구면렌즈대응치가 안과의사군에서 비전문가군에 비해 근시인 것(-0.77 ± 1.59 디옵터[diopters, D] vs. -0.19 ± 1.48 D, p=0.03)을 제외하고는 두 군 간 차이가 없었다. 두 군에서 나이와 사시안의 구면렌즈대응치를 짝지은 39쌍을 비교하면, 안과의사군에서 원거리, 근거리 실제사시각이 비전문가군에 비해 작았지만(24.0 ± 6.8 PD vs. 28.5 ± 6.4 PD, 26.9 ± 6.6 PD vs. 31.0 ± 6.4 PD, p&lt;0.01), 사진사시각을 비롯한 다른 특징은 차이가 없었다. <br>결론: 수술이 필요한 정도의 간헐외사시라도 사시각이 작거나 근시가 동반된 경우 안과의사가 검진을 통해 처음 발견하는 경우가 많았다.