Postoperative exodrift remains a major challenge following surgical correction of intermittent exotropia (IXT), and evidence supporting adjunctive strategies to improve long-term alignment is limited. This study evaluated the effect of alternate eye patching on 12-month postoperative alignment stability after successful surgical correction in divergence excess IXT. This randomised clinical trial was conducted at an institutional tertiary care centre and included 60 children (3–12 years) undergoing bilateral lateral rectus recession who were randomised only after confirmation of early postoperative alignment ( ≤ 10 prism dioptres [PD]), creating a post-success randomised design to evaluate the effect of alternate eye patching on alignment maintenance. Participants were assigned to alternate eye patching (Group A) or standard postoperative care (Group B). Patching was prescribed for 1 h daily per eye for 3 months. Patients were followed for 12 months. The primary outcome was alignment stability ( ≤ 10 PD). Secondary outcomes included exodrift ( > 10 PD), mean deviation, and reoperation rate. At 12 months, alignment stability was significantly higher in Group A compared with Group B (83.3% vs 60.0%, p = 0.045). Significant exodrift occurred less frequently in Group A (16.7% vs 40.0%, p = 0.045). Mean postoperative deviation was lower in Group A at all follow-up visits (p < 0.05). No patients in Group A required reoperation compared with 10% in Group B, although this difference was not statistically significant (p = 0.112). Alternate eye patching may improve postoperative alignment stability and reduce postoperative exodrift for divergence excess intermittent exotropia. Early postoperative modulation of binocular visual balance may contribute to improved long-term alignment outcomes. Pan African Clinical Trial Registry (PACTR202505751499770), registered on May 14, 2025. https://pactr.samrc.ac.za/
Patients often spend significant time in clinic waiting rooms. This study assessed the feasibility of using this “wasted” time to perform self-administered vision assessments directly within the waiting area. Glaucoma patients attending routine appointments were asked to complete either a pen-and-paper (SpotChecks) or digital (PopCSF) contrast sensitivity (CS) test. Ambient illuminance, background noise, and crowd levels were recorded to assess potential environmental confounds. Test durations and patient feedback were recorded. Visual-Functioning Index-7 (VF-7) and Pelli-Robson CS (reference) test results were collected for comparison. Of 173 patients approached, 155 (89.6%) agreed to participate, and 151(97.4%) participants completed testing before their appointment (77/78 pen-and-paper; 74/74 digital). Environmental factors had no significant impact (all P > 0.05). Median completion times were 3.0 {2.6–4.5} minutes (pen-and-paper) and 2.5 {2.0–3.5} minutes (digital). Age did not impact the pen-and-paper test duration (P = 0.944) but weakly correlated with the digital test duration (rdigital = 0.27, P = 0.020). Functional CS scores correlated with Pelli-Robson reference measurements (rpen-and-paper = 0.81; rdigital = 0.62), age (rpen-and-paper = –0.58; rdigital = –0.37), logMAR visual acuity (rpen-and-paper = –0.42; rdigital = –0.44), and visual field mean deviation scores (rpen-and-paper = –0.54; rdigital = –0.63). Both tests were highly acceptable to patients ( > 80% on all questions). Visit durations were longer for participants (109 vs 88 min, P = 0.007), but this was attributed to consenting and related research activities rather than the tests themselves. This proof-of-concept study demonstrates that it is feasible for patients to self-administer portable vision tests in clinic waiting rooms. Using CS as a representative example, this approach may enable additional data collection, potentially improving patient management, clinic flow, and/or patient satisfaction.
