Effects of Home-Based Antisuppression and Binocular Integration Training in Patients with Intermittent Exotropia: A Retrospective Study

Abstract

Objective To evaluate the association between 6-month home-based antisuppression with binocular integration training with binocular sensory outcomes and the 2-year surgical rate in patients with intermittent exotropia (IXT). Methods In this retrospective cohort study, patients diagnosed with IXT were included and classified into training and control groups according to their treatment history. The primary outcome was improvement in fine stereopsis (FS) at 6 months. Secondary outcomes included improvements in coarse stereopsis (CS), dynamic stereopsis (DS), peripheral suppression (PS), foveal suppression (FoS) at 6 months, and surgical rate within 2 years. Propensity score matching and inverse probability of treatment weighting were applied to balance baseline characteristics. Relative risks were estimated using univariable and multivariable log-binomial regression. Subgroup analyses were performed for the primary outcome. Results A total of 252 patients were included. At 6 months, the training group showed significantly higher improvement rates than the control group in FS (61.54% vs 32.11%, P=0.0001), DS (49.65% vs 31.19%, P=0.0050), and CS (41.96% vs 22.94%, P=0.0025). The training group also had a significantly lower surgical rate within 2 years (8.39% vs 18.35%, P=0.0118). No significant differences were observed in PS or FoS. Subgroup analysis identified no significant interactions of FS improvements. Conclusion Home-based antisuppression with binocular integration training was associated with improved binocular sensory outcomes and a lower 2-year surgical rate in patients with IXT. These findings suggest that this intervention may represent a potential adjunctive non-surgical treatment option.