Base-in Prism Spectacles for Intermittent Exotropia

NCT ID: NCT03998670

Last Updated: 2023-10-04

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

61 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-01

Study Completion Date

2020-07-30

Brief Summary

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The objective of this short-term, pilot randomized trial comparing spectacles with relieving prism to spectacles without prism is to determine whether to proceed to a full-scale, longer-term randomized trial. This decision will be based primarily on assessing the initial (8-week) response to prism by comparing treatment groups on the following outcomes:

* Mean distance intermittent exotropia (IXT) control score (the mean of 3 control scores) (primary outcome)
* The proportion of participants demonstrating a "treatment response," defined as ≥1 point improvement in the mean distance IXT control score without spontaneous exotropia during control testing (secondary outcome)
* The proportion of participants reporting adverse effects and good/excellent spectacle wear compliance

Detailed Description

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Conditions

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Exotropia Intermittent

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
At the 8-week outcome visit, a Masked Examiner, who is a pediatric ophthalmologist, pediatric optometrist, or certified orthoptist, will assess the control of the exodeviation and perform PACT testing. The Masked Examiner must be someone other than the investigator.

Study Groups

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Prism Group

Spectacles with refractive correction and base-in relieving prism (40% of the greater of the exodeviation by prism and alternate cover test (PACT) at distance or near) equally divided between the 2 lenses will be prescribed to the participant

Group Type EXPERIMENTAL

Prism Glasses

Intervention Type DEVICE

Spectacles with refractive correction and base-in relieving prism (40% of the greater of the exodeviation by PACT at distance or near) equally divided between the 2 lenses

Non-Prism Group

Spectacles with refractive correction (or plano spectacles if no significant refractive error) and no prism will be prescribed to the participant

Group Type PLACEBO_COMPARATOR

Non-Prism Glasses

Intervention Type DEVICE

Spectacles with refractive correction (or plano spectacles if no significant refractive error) and no prism

Interventions

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Prism Glasses

Spectacles with refractive correction and base-in relieving prism (40% of the greater of the exodeviation by PACT at distance or near) equally divided between the 2 lenses

Intervention Type DEVICE

Non-Prism Glasses

Spectacles with refractive correction (or plano spectacles if no significant refractive error) and no prism

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

Intermittent Exotropia meeting all of the following criteria:

* Age 3 to 13 years
* Mean distance control score of ≥2.00 points with at least 1 measure of 3, 4, or 5 points (i.e, spontaneous tropia) from the 3 assessments during the exam
* A near control score ≤4 on at least 1 of 3 assessments (cannot have score of 5, 5, 5)
* Distance exodeviation between 16 Prism Diopters (Δ) and 35 Δ (inclusive) by PACT
* Near exodeviation between 10 Δ and 35 Δ (inclusive) by PACT
* Near deviation does not exceed distance deviation by more than 10 Δ by PACT (i.e., convergence insufficiency-type IXT excluded)
* Refractive error between -6.00 Diopters (D) spherical equivalent (SE) and +2.50 D SE (inclusive) (based on a cycloplegic refraction performed within 7 months but prior to the day of enrollment)
* Refractive correction (must be worn for at least 1 week if refractive error meets any of the following (based on a cycloplegic refraction performed within 7 months but prior to the day of enrollment):

* SE anisometropia ≥1.00 D
* Astigmatism ≥1.00 D in either eye
* SE myopia ≥-0.50 D in either eye
* If spectacles have been prescribed and are worn, they must meet the following pre- enrollment criteria:

* SE anisometropia corrected to within 1.00 D of full SE anisometropic difference
* Astigmatism corrected to within 1.00 D of full magnitude; axis within 10 degrees if astigmatism ≤1.00 D and axis within 5 degrees if astigmatism \>1.00 D

Exclusion Criteria

* Dissociated vertical deviation (DVD)
* Vertical deviation \>3 Δ in primary gaze at distance or near
* Patterns (such as an "A" or "V" pattern) with a downgaze measurement of \>10 Δ difference from straight ahead by PACT, measured per investigator's routine method
* Treatment for IXT or amblyopia (other than refractive correction) within the past 4 weeks, including vision therapy, orthoptics, patching, atropine, or other penalization
* Substantial overminus spectacles (spectacles overminused by more than 1.00 D SE than the most recent cycloplegic refraction and also results in minus SE power in the spectacles; underplussing is allowed) within the past 4 weeks
* Prior strabismus, intraocular, or refractive surgery (including BOTOX injection)
* Previous use of prism spectacles

Additional Eligibility Criteria for Randomization Based on Prism Adaptation Testing

* Exodeviation by PACT while wearing "trial" relieving prism for 30 minutes is smaller at distance or near than measured during initial testing (e.g. not fully adapting to prism at both distances)
* No new esotropia on cover test at near while wearing "trial" relieving prism for 30 minutes, compared with enrollment measurement taken without prism
* No esodeviation \>6 Δ on PACT at near while wearing "trial" relieving prism for 30 minutes
Minimum Eligible Age

3 Years

Maximum Eligible Age

13 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Pediatric Eye Disease Investigator Group

NETWORK

Sponsor Role collaborator

National Eye Institute (NEI)

NIH

Sponsor Role collaborator

Jaeb Center for Health Research

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David G Morrison, MD

Role: STUDY_CHAIR

Vanderbilt University Medical Center

Allison I Summers, OD, MCR

Role: STUDY_CHAIR

Oregon Health and Science University

Locations

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UAB Pediatric Eye Care; Birmingham Health Care

Birmingham, Alabama, United States

Site Status

Midwestern University Eye Institute

Glendale, Arizona, United States

Site Status

Arkansas Childrens

Little Rock, Arkansas, United States

Site Status

Southern California College of Optometry

Fullerton, California, United States

Site Status

Western University College of Optometry

Pomona, California, United States

Site Status

Nova Southeastern University College of Optometry, The Eye Institute

Fort Lauderdale, Florida, United States

Site Status

Ann & Robert H. Lurie Children's Hospital of Chicago

Chicago, Illinois, United States

Site Status

Illinois College of Optometry

Chicago, Illinois, United States

Site Status

University of Chicago

Hyde Park, Illinois, United States

Site Status

Indiana School of Optometry

Bloomington, Indiana, United States

Site Status

Indiana University School of Optometry

Indianapolis, Indiana, United States

Site Status

Wolfe Eye Clinic

West Des Moines, Iowa, United States

Site Status

University of Kentucky Department of Neurology

Lexington, Kentucky, United States

Site Status

Wilmer Eye Institute

Baltimore, Maryland, United States

Site Status

Boston Medical Center

Boston, Massachusetts, United States

Site Status

Boston Children's Hospital Waltham

Boston, Massachusetts, United States

Site Status

Pediatric Ophthalmology, P.C.

Grand Rapids, Michigan, United States

Site Status

University of Nebraska Medical Center

Omaha, Nebraska, United States

Site Status

Cincinnati Children's Hospital

Cincinnati, Ohio, United States

Site Status

Ohio State University College of Optometry

Columbus, Ohio, United States

Site Status

OHSU Casey Eye Institute

Portland, Oregon, United States

Site Status

Pediatric Ophthalmology of Erie

Erie, Pennsylvania, United States

Site Status

Salus University/Pennsylvania College of Optometry

Philadelphia, Pennsylvania, United States

Site Status

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status

Texas Children's Hospital - Dept. Of Ophthalmology

Houston, Texas, United States

Site Status

Houston Eye Associates

The Woodlands, Texas, United States

Site Status

Virginia Pediatric Eye Center

Norfolk, Virginia, United States

Site Status

Gundersen Health System

La Crosse, Wisconsin, United States

Site Status

Countries

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United States

References

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Summers AI, Morrison DG, Chandler DL, Henderson RJ, Chen AM, Leske DA, Walker KR, Li Z, Melia BM, Bitner DP, Kurup SP, Allen M, Phillips PH, Nash DL, Grigorian AP, Kraus CL, Miller AM, Titelbaum JR, Kraker RT, Holmes JM, Cotter SA; Pediatric Eye Disease Investigator Group. A Pilot Randomized Clinical Trial of Base-in Relieving Prism Spectacle Treatment of Intermittent Exotropia. Optom Vis Sci. 2023 Jul 1;100(7):432-443. doi: 10.1097/OPX.0000000000002039. Epub 2023 Jul 1.

Reference Type RESULT
PMID: 37399233 (View on PubMed)

Hatt SR, Leske DA, Holmes JM, Henderson RJ, Chandler DL, Morrison DG, Summers AI, Cotter SA. Testing depth of suppression in childhood intermittent exotropia. J AAPOS. 2022 Feb;26(1):36-38.e1. doi: 10.1016/j.jaapos.2021.08.303. Epub 2021 Nov 16.

Reference Type RESULT
PMID: 34793970 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Related Links

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https://public.jaeb.org/pedig

PEDIG Public Website

Other Identifiers

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2UG1EY011751

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IXT6

Identifier Type: -

Identifier Source: org_study_id

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