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AAO 2023: Insights From the Pediatric Eye Disease Investigator Group Studies

Op-Med is a collection of original articles contributed by Doximity members.

The 2023 American Academy of Ophthalmology course, "Exotropia: State of the Art 2023," delved into crucial insights from recent Pediatric Eye Disease Investigator Group (PEDIG) studies, offering a scintillating exploration of exotropia diagnosis and management.

Highlighted during the course were three pivotal PEDIG studies, presented and co-authored by Benjamin Ticho MD. The first investigated the efficacy of Overminus glasses, shedding light on their role in exotropia treatment. The second delved into part-time patching, unraveling its effectiveness for intermittent exotropia. Lastly, a comparative analysis of symmetric bilateral lateral rectus recessions versus recess-respect procedures provided nuanced perspectives on surgical interventions.

These studies collectively enriched the understanding of exotropia, offering evidence-based approaches for clinicians. 

The article investigates the long-term effects of overminus lens treatment on refractive error in children with intermittent exotropia. The study found that overminus lenses resulted in a greater myopic shift compared to nonoverminus lenses after one year of treatment. Importantly, this myopic shift persisted over the 2-year period after discontinuing overminus spectacles. The study warns clinicians of the long-term refractive risk of this particular nonsurgical treatment for managing childhood intermittent exotropia.

This second PEDIG study, also published this year, compared part-time patching to observation in 306 participants aged 3 to under 11. Focused on distance control, the research reveals that, at 3 and 6 months, part-time patching demonstrates a mean difference of 0.4 and 0.3 points, respectively, in control scores compared to observation. Notably, 29% of patched participants exhibit a 2-point or more improvement at 3 months, compared to 18% in the observation group. The findings suggest potential benefits of part-time patching but emphasize that the treatment effects are small and possibly not stable after part-time patching is discontinued. 

The third PEDIG 2023 publication studied 197 children aged 3 to under 11 with basic-type intermittent exotropia (IXT) randomized to bilateral lateral rectus recession (BLRc) versus unilateral lateral rectus recession combined with medial rectus resection in the same eye (R&R). While the initial results showed little outcome difference between the two surgical approaches, follow-up study spanning 8 years suggested that unilateral R&R might yield slightly better long-term outcomes than BLRc for basic-type childhood IXT.  

Among the 123 participants who continued follow-up after the 3-year primary outcome visit, the cumulative probability of suboptimal surgical outcome by 8 years was 68% for BLRc and 53% for R&R. Although the primary outcome difference wasn't statistically significant, secondary outcomes showed notable distinctions. Complete or near-complete resolution at 8 years was 15% for BLRc and 37% for R&R. The cumulative probability of reoperation was 30% for BLRc and 11% for R&R. Dr. Ticho opined no strong preference for one surgical approach over the other for childhood IXT. 

Dr. Ticho is an Associate Professor of Ophthalmology at The University of Illinois at Chicago. His participation in the three PEDIG studies took place in private practice at Ticho Eye Associates. 

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