ABSTRACT Purpose To determine whether 3 months of prescribed full‐time alternate patching is more effective than observation for intermittent exotropia (IXT) in children. Methods We enrolled 73 children aged 3 to 10Δ. Children were randomly assigned to 3 months full‐time patching (all waking hours, 7 days per week, alternating eyes) or observation. The primary outcome was change in mean distance IXT control at 3 months. Results Baseline mean (SD) distance control for children assigned to full‐time patching ( N = 36) and observation ( N = 37) were 3.6 (0.9) and 3.6 (0.9) points; mean distance PACT was 27Δ (9) and 27Δ (8), respectively. The 3‐month visit was completed by 33 (92%) of 36 and 35 (95%) of 37 children assigned to full‐time patching and observation. Mean patching adherence was 4.1 h per day (95% CI: 2.8–5.5, N = 20) by participants who returned temperature sensor occlusion dose monitors and 7.4 h per day (95% CI: 5.8–8.9, N = 33) by review of at‐home calendars and interviews with parent and child. At 3 months, children in the patching group had greater improvement in mean distance control than the observation group: 0.9 (1.3) versus 0.2 (1.1) points (difference = 0.62 points, 95% CI: 0.04–1.20, p = 0.04). There was also greater improvement in mean distance PACT: 6 (7) versus 2 (7) Δ, difference = 4Δ (95% CI: 1–8, p = 0.02). Conclusions Three months of prescribed full‐time alternate day patching improved distance control and magnitude of IXT in children 3‐<9 years, despite mean adherence substantially less than the prescribed full‐time regimen. Future studies should evaluate the durability of treatment effects and compare patching to other treatments. Trial Registration Clinicaltrials.Gov, registered 14 July 2022, NCT05462821.
Jenewein et al. (Sun,) studied this question.