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Exotropia IntermittentIXT6NCT03998670

Base-in Prism Spectacles for Intermittent Exotropia

A study testing Prism Glasses and Non-Prism Glasses in people with Exotropia Intermittent, run by Jaeb Center for Health Research at 28 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

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. Read more about this study

Who is it for?
Ages 3 to 13 years
Conditions the study is for
Exotropia Intermittent
What is being tested?
Prism Glasses and Non-Prism Glasses
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
61 participants
Where
28 sitesUnited States
Study dates
1 Sep 2019to 30 Jul 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 3 to 13 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • 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
Show all 15Show fewer
  • 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

Who cannot join

  • 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)
Show all 11Show fewer
  • 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

Trial locations and contacts

28 sites in 1 country.

28 sites in 1 country

United States28 sites
  • Wilmer Eye Institute

    Baltimore, Maryland, 21287-9028

  • UAB Pediatric Eye Care; Birmingham Health Care

    Birmingham, Alabama, 35294

  • Indiana School of Optometry

    Bloomington, Indiana, 47405

  • Boston Medical Center

    Boston, Massachusetts, 02118

  • Boston Children's Hospital Waltham

    Boston, Massachusetts, 02453

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

    Chicago, Illinois, 60611

  • Illinois College of Optometry

    Chicago, Illinois, 60616

  • Cincinnati Children's Hospital

    Cincinnati, Ohio, 45229

  • Ohio State University College of Optometry

    Columbus, Ohio, 43210-1280

  • Pediatric Ophthalmology of Erie

    Erie, Pennsylvania, 16501

  • Nova Southeastern University College of Optometry, The Eye Institute

    Fort Lauderdale, Florida, 33382

  • Southern California College of Optometry

    Fullerton, California, 92831-1699

  • Midwestern University Eye Institute

    Glendale, Arizona, 85308

  • Pediatric Ophthalmology, P.C.

    Grand Rapids, Michigan, 49546

  • Texas Children's Hospital - Dept. Of Ophthalmology

    Houston, Texas, 77030

  • University of Chicago

    Hyde Park, Illinois, 60637

  • Indiana University School of Optometry

    Indianapolis, Indiana, 47405

  • Gundersen Health System

    La Crosse, Wisconsin, 54601

  • University of Kentucky Department of Neurology

    Lexington, Kentucky, 40536

  • Arkansas Childrens

    Little Rock, Arkansas, 72202

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

  • Virginia Pediatric Eye Center

    Norfolk, Virginia, 23502

  • University of Nebraska Medical Center

    Omaha, Nebraska, 68114

  • Salus University/Pennsylvania College of Optometry

    Philadelphia, Pennsylvania, 19141

  • Western University College of Optometry

    Pomona, California, 91766

  • OHSU Casey Eye Institute

    Portland, Oregon, 97239

  • Houston Eye Associates

    The Woodlands, Texas, 77381

  • Wolfe Eye Clinic

    West Des Moines, Iowa, 50266

Other trials in United States

About this study

Official title: Intermittent Exotropia Study 6: A Pilot Randomized Clinical Trial of Base-in Prism Spectacles for Intermittent Exotropia

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
Being tested
Prism Glasses, Non-Prism Glasses
Keywords
Prism

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Prism GlassesDevice

    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 GlassesDevice

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

Study groups in NCT03998670
Study groupRoleWhat they receive
Prism GroupExperimentalSpectacles 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
Receives: Device: Prism Glasses
Non-Prism GroupPlacebo comparatorSpectacles with refractive correction (or plano spectacles if no significant refractive error) and no prism will be prescribed to the participant
Receives: Device: Non-Prism Glasses

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Exotropia Control Score at Distance, Continuous Score

    The primary analysis will be an intent-to-treat comparison of mean 8-week control of the distance exodeviation (average of 3 measurements) between treatment groups using an analysis of covariance (ANCOVA) model, which adjusts for baseline distance control. Distance control scores range from 0 to 5 with higher scores indicating a worse outcome.

    Measured: 8 weeks

Secondary outcomes (22)
  1. Exotropia Control Score at Distance, % With Treatment Response

    The secondary analysis will calculate the percentage of participants with a "treatment response," defined as ≥1 point improvement in control of their distance exodeviation (average of 3 measurements) between baseline and the 8-week outcome exam.

    Measured: 8 weeks

  2. Exotropia Control Score at Distance and Near, % With No Spontaneous Tropia

    The proportion of participants with no spontaneous tropia at 8 weeks will be compared between treatment groups using a two-sided Barnard's test with alpha of 0.05, with calculation of a two-sided 95% confidence interval on the difference in proportions.

    No spontaneous tropia at the 8-week primary outcome exam is defined as a score of ≤2 (0, 1, or 2) on all three assessments of control at distance and at near.

    Measured: 8 Weeks

  3. Exotropia Control Score at Distance, Continuous Change Between Baseline and 8 Weeks

    Control of the exodeviation was measured at distance using the IXT Office Control Score, (Mohney, 2006) which ranges from 0 (phoria) to 5 (constant exotropia). Control levels 3-5 were assigned based on the duration of manifest exotropia during a 30-second period before any dissociation. If no exotropia was observed, control levels 0-2 were assigned based on the longest time to reestablishing fusion after 3 consecutive 10-second periods of dissociation. Control was measured at the beginning, middle, and end (3 tests) of a 20- to 40-minute office examination, and the mean was used. The change in distance control from baseline to 8 weeks will be calculated. A negative value indicates improvement.

    Measured: 8 Weeks

  4. Exotropia Control Score at Near, Continuous Score

    Near control will be evaluated similarly to the primary outcome and outcome measures 2-4. Near control scores range from 0 to 5 with higher scores indicating a worse outcome.

    Measured: 8 Weeks

  5. Exodeviation by PACT at Distance, Continuous

    The measure of ocular alignment at distance by PACT will be summarized at 8 weeks for each treatment group. A higher deviation is worse.

    Measured: 8 Weeks

  6. Exodeviation by PACT at Near, Continuous

    The measure of ocular alignment at near by PACT will be summarized at 8 weeks for each treatment group. A higher deviation is worse.

    Measured: 8 Weeks

  7. Randot Preschool Stereoacuity at Near, Continuous

    Randot® Preschool Stereoacuity test (Stereo Optical Co., Inc., Chicago, IL). For analysis, stereoacuity was converted from seconds of arc scores to log arcsec values (in parentheses) as follows: 40 (1.60), 60 (1.78), 100 (2.00), 200 (2.30), 400 (2.60), 800 (2.90); participants with no detectable (nil) stereoacuity were assigned the value of 1600 (3.20). The measure of Randot Preschool Stereoacuity at near will be summarized at 8 weeks for each treatment group. A lower score is better.

    Measured: 8 Weeks

  8. Compliance of Spectacle Wear

    Parents will be asked to complete a compliance calendar by recording the percentage of time their child has worn the study-prescribed spectacle correction each day. Proportion of time worn each day will be described as excellent (76% to 100%), good (51% to 75%), fair (26% to 50%), poor (1 to 25%), or none (0%). Based on review of the calendars and discussion with parents at the 8-week outcome exam, the investigator will record the total proportion of time worn as excellent (76% to 100%), good (51% to 75%), fair (26% to 50%), poor (1 to 25%), or none (0%: did not fill prescription or never picked up spectacles).

    The distribution of compliance will be assessed for each treatment group at the outcome exam.

    Measured: 8 weeks

  9. Child Assessment of Symptoms - Do Your Eyes Hurt?

    Adverse symptoms of intermittent exotropia will be summarized at the 8-week outcome exam using a symptom survey that is administered to the child. Response options are based on frequency of observations: never, sometimes, and always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  10. Child Assessment of Symptoms - Do Your Eyes Feel Funny?

    Adverse symptoms of intermittent exotropia will be summarized at the 8-week outcome exam using a symptom survey that is administered to the child. Response options are based on frequency of observations: never, sometimes, and always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  11. Child Assessment of Symptoms - Do You Have Double Vision?

    Adverse symptoms of intermittent exotropia will be summarized at the 8-week outcome exam using a symptom survey that is administered to the child. Response options are based on frequency of observations: never, sometimes, and always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  12. Child Assessment of Symptoms - Is it Hard for You to Stare at Things?

    Adverse symptoms of intermittent exotropia will be summarized at the 8-week outcome exam using a symptom survey that is administered to the child. Response options are based on frequency of observations: never, sometimes, and always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  13. Child Assessment of Symptoms - Do You Have Problems With Your Eyes in the Sun?

    Adverse symptoms of intermittent exotropia will be summarized at the 8-week outcome exam using a symptom survey that is administered to the child. Response options are based on frequency of observations: never, sometimes, and always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  14. Child Assessment of Symptoms - Do Your Eyes go in and Out?

    Adverse symptoms of intermittent exotropia will be summarized at the 8-week outcome exam using a symptom survey that is administered to the child. Response options are based on frequency of observations: never, sometimes, and always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  15. Child Assessment of Symptoms - Is it Hard to Focus Your Eyes?

    Adverse symptoms of intermittent exotropia will be summarized at the 8-week outcome exam using a symptom survey that is administered to the child. Response options are based on frequency of observations: never, sometimes, and always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  16. Parent Assessment of Symptoms and Spectacle Wear - Has Your Child Had Headaches?

    Adverse symptoms of intermittent exotropia and spectacle wear will be summarized at the 8-week outcome exam using a symptom survey that is administered to the parent.

    Response options are based on frequency of observations: never, almost never, sometimes, often, and almost always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  17. Parent Assessment of Symptoms and Spectacle Wear - Has Your Child Had Eyestrain?

    Adverse symptoms of intermittent exotropia and spectacle wear will be summarized at the 8-week outcome exam using a symptom survey that is administered to the parent.

    Response options are based on frequency of observations: never, almost never, sometimes, often, and almost always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  18. Parent Assessment of Symptoms and Spectacle Wear - Has Your Child Avoided Reading or Doing Things up Close?

    Adverse symptoms of intermittent exotropia and spectacle wear will be summarized at the 8-week outcome exam using a symptom survey that is administered to the parent.

    Response options are based on frequency of observations: never, almost never, sometimes, often, and almost always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  19. Parent Assessment of Symptoms and Spectacle Wear - Has Your Child Reported Blurry Vision?

    Adverse symptoms of intermittent exotropia and spectacle wear will be summarized at the 8-week outcome exam using a symptom survey that is administered to the parent.

    Response options are based on frequency of observations: never, almost never, sometimes, often, and almost always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  20. Parent Assessment of Symptoms and Spectacle Wear - Has Your Child Looked Over His or Her Spectacles?

    Adverse symptoms of intermittent exotropia and spectacle wear will be summarized at the 8-week outcome exam using a symptom survey that is administered to the parent.

    Response options are based on frequency of observations: never, almost never, sometimes, often, and almost always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  21. Parent Assessment of Symptoms and Spectacle Wear - Has Your Child Taken His/Her Spectacles Off When he/She Should be Wearing Them?

    Adverse symptoms of intermittent exotropia and spectacle wear will be summarized at the 8-week outcome exam using a symptom survey that is administered to the parent.

    Response options are based on frequency of observations: never, almost never, sometimes, often, and almost always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

  22. Parent Assessment of Symptoms and Spectacle Wear - Has Your Child Complained That the Spectacles Hurt His/Her Ears and/or Nose?

    Adverse symptoms of intermittent exotropia and spectacle wear will be summarized at the 8-week outcome exam using a symptom survey that is administered to the parent.

    Response options are based on frequency of observations: never, almost never, sometimes, often, and almost always. The distribution of scores on each survey item will be tabulated by treatment group after 8-weeks.

    Measured: 8 Weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Jun 2019
  2. Study start1 Sep 2019
  3. Primary completion30 Jul 2020
  4. Study completion30 Jul 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
61 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03998670
Sponsor's protocol ID
IXT6
Other IDs
2UG1EY011751
Acronym
IXT6
Status last verified
Sep 2023
First submitted
24 Jun 2019
Last updated
4 Oct 2023
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: In accordance with the NIH data sharing policy, a de-identified database is placed in the public domain on the Pediatric Eye Disease Investigator Group (PEDIG) public website after the completion of each protocol and publication of the primary manuscript.

Publications

  • 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.

    PubMed 37399233
  • 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.

    PubMed 34793970

Questions about this trial

What is this clinical trial studying?

A study testing Prism Glasses and Non-Prism Glasses in people with Exotropia Intermittent, run by Jaeb Center for Health Research at 28 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 28 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 17 Oct 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Exotropia Control Score at Distance, Continuous Score (time frame: 8 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03998670, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Oct 2023.

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