Virtual reality–based vision therapy could be associated with improved distance exotropia control compared with observation in pediatric patients with intermittent exotropia in a multicenter, randomized clinical trial of 177 patients.
In the study, conducted at three tertiary hospitals in China between July 1, 2023 and November 17, 2024, researchers found that the patients who completed a 12-week home-based virtual reality training program showed greater improvement in distance exotropia control scores compared with those assigned to observation alone.
Patients aged 6 to 18 years with untreated intermittent exotropia and exodeviation magnitude of 10 to 30 prism diopters were randomly assigned to virtual reality vision therapy or observation.
The therapy program consisted of fivet weekly sessions using a virtual reality headset, with each session including two 15-minute training periods. Exercises included dichoptic tasks designed to strengthen binocular fusion and stereoscopic tasks to improve stereoacuity.
Among the patients, 161 were included in the full analysis set. The median age was 8 years and 54% were male.
At 12 weeks, the median change in distance exotropia control score was −0.33 in the therapy group vs no change in the observation group, representing a −0.33-point difference favoring therapy. A total of 30% of the treated patients achieved at least a 1-point improvement in the distance exotropia control score compared with 11% in the control group.
The patients who completed more than 75% of the prescribed sessions had a larger improvement in distance control score, with a −0.71-point difference vs observation. Minimal differences were seen in patients with lower adherence.
Subgroup analysis showed greater treatment benefit among patients with baseline distance control scores of two or higher, with a −0.67-point difference compared with observation. Age and sex didn't significantly modify the treatment effects.
Compared with observation, therapy was also associated with modest improvements in the near exotropia control score, magnitude of exodeviation at distance and near, and near point of convergence. However, no statistically significant differences were observed in stereoacuity, fusional convergence or divergence amplitudes, refractive error, axial length, or quality-of-life scores.
No adverse events related to the intervention were identified.
“[C]hildren with [intermittent exotropia] had a statistically significant, albeit modest, improvement in distance exotropia control score after 12 weeks of [virtual reality–based vision therapy],” wrote lead study author Yu Jing, MM, of The First Affiliated Hospital with Nanjing Medical University in China, and colleagues.
The researchers reported no conflicts of interest.
Source: JAMA Network Open
