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| ID | Type | Description | Link |
|---|---|---|---|
| 2U10EY011751 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| Pediatric Eye Disease Investigator Group | NETWORK |
| National Eye Institute (NEI) | NIH |
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The objective of this short-term, pilot randomized trial comparing 2.50 diopters (D) overminus lens treatment vs. non-overminus (spectacles without overminus or no spectacles) in children with intermittent exotropia (IXT) 3 to <7 years of age is to determine whether to proceed to a full-scale, longer-term randomized trial.
The objective of this short-term, pilot randomized trial comparing 2.50D overminus lens treatment vs. non-overminus (spectacles without overminus or no spectacles) 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 overminus by comparing treatment groups on the following outcomes:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Overminus Treatment | Experimental | 2.50D overminus spectacles |
|
| Non-overminus Treatment | Active Comparator | spectacles without overminus or no spectacles |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Overminus treatment | Device | 2.50D overminus spectacles |
|
| Measure | Description | Time Frame |
|---|---|---|
| Mean Distance Exotropia Control Score | At each visit, control of the exodeviation was measured at distance (6 meters) and at near (1/3 meters) using the Office Control Score* which ranges from 0 (phoria, best control) to 5 (constant exotropia, worst control). Due to the variability of single measures of control, we used a "triple control score," which is a mean of 3 measures obtained at specific time-points during a 20- to 40-minute office examination. The primary analysis was an intention-to-treat treatment group comparison of mean 8-week distance control using an analysis of covariance (ANCOVA) model which adjusted for baseline distance control. *Mohney BG, Holmes JM. An office-based scale for assessing control in intermittent exotropia. Strabismus 2006;14(3):147-50. | 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Mean Near Exotropia Control Score | At each visit, control of the exodeviation was measured at near (1/3 meters) using the Office Control Score which ranges from 0 (phoria, best control) to 5 (constant exotropia, worst control). Due to the variability of single measures of control, we used a "triple control score," which is a mean of 3 measures obtained at specific time-points during a 20- to 40-minute office examination. The secondary analysis was an intention-to-treat treatment group comparison of mean 8-week near control using an analysis of covariance (ANCOVA) model which adjusted for baseline near control. |
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The following criteria must be met for the child to be enrolled in the study:
Age 3 years to < 7 years
Intermittent exotropia (manifest deviation) meeting all of the following criteria:
Intermittent exotropia or constant exotropia at distance
Intermittent exotropia, exophoria, or orthophoria at near
Exodeviation at least 15∆ at distance measured by PACT
Near deviation does not exceed distance deviation by more than 10∆ by PACT (convergence insufficiency type IXT excluded)
No previous non-surgical treatment for IXT (other than refractive correction), including vision therapy for IXT, within the past 6 months.
No previous substantial overminus treatment, defined as wearing spectacles that are overminused by 1.00D SE or more (treatment with lenses overminused by less than 1.00D SE is allowed at any time prior to enrollment).
No vision therapy, patching, atropine, or other penalization for amblyopia during the last 2 weeks
No prior strabismus, intraocular, or refractive surgery (including BOTOX injection)
Cycloplegic refraction within 7 months, but NOT on the day of enrollment
Spherical equivalent (SE) in both eyes between -6.00D and +1.00D inclusive
Distance visual acuity 0.3 logMAR (20/40) or better (by ATS-HOTV) in both eyes
No interocular difference of distance visual acuity more than 0.2 logMAR (2 lines)
Child must be wearing refractive correction (pre-study spectacles) for at least 1 week if refractive error (based on cycloplegic refraction performed within 7 months) meets any of the following:
Refractive correction must meet the following criteria relative to the cycloplegic refraction:
SE anisometropia must be within <1.0D of the SE anisometropic difference
Astigmatism must be within <1.00D of full magnitude; axis must be within 10 degrees if ≤1.00D, and within 5 degrees if >1.00D.
The SE of the spectacles must be within <1.00D of the full cycloplegic refraction SE.
No current contact lens wear
No abnormality of the cornea, lens, or central retina
Gestational age ≥ 32 weeks
Birth weight > 1500 grams
No Down syndrome or cerebral palsy
No severe developmental delay which would interfere with treatment or evaluation (in the opinion of the investigator). Subjects with mild speech delays or reading and/or learning disabilities are not excluded.
No disease known to affect accommodation, vergence, and ocular motility such as multiple sclerosis, Graves orbitopathy, myasthenia gravis, diabetes mellitus, or Parkinson disease
No current use of any ocular or systemic medication known to affect accommodation or vergence, such as anti-anxiety agents (e.g., Librium or Valium), anti-arrhythmic agents (e.g., Cifenline, Cibenzoline), anti-cholinergics (e.g., motion sickness patch (scopolamine)), bladder spasmolytic drugs (e.g., Propiverine), hydroxychloroquine, chloroquine, phenothiazines (e.g., Compazine, Mellaril, Thorazine), tricyclic antidepressants (e.g., Elavil, Nortriptyline, Tofranil)
Parent understands the protocol and is willing to accept randomization to overminus spectacles or non-overminus status
Parent has home phone (or access to phone) and is willing to be contacted by Jaeb Center staff and Investigator's site staff
Relocation outside of area of an active PEDIG site within next 8 weeks is not anticipated
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| Name | Affiliation | Role |
|---|---|---|
| Jonathan M Holmes, MD | Mayo Clinic | Study Chair |
| Angela M Chen, OD, MS | Marshall B. Ketchum University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Marshall B. Ketchum University | Fullerton | California | 92831 | United States | ||
| Mayo Clinic |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27506485 | Result | Pediatric Eye Disease Investigator Group; Chen AM, Holmes JM, Chandler DL, Patel RA, Gray ME, Erzurum SA, Wallace DK, Kraker RT, Jensen AA. A Randomized Trial Evaluating Short-term Effectiveness of Overminus Lenses in Children 3 to 6 Years of Age with Intermittent Exotropia. Ophthalmology. 2016 Oct;123(10):2127-36. doi: 10.1016/j.ophtha.2016.06.042. Epub 2016 Aug 6. |
| Label | URL |
|---|---|
| PEDIG Public Website | View source |
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In accordance with the NIH data sharing policy, a de-identified database is placed in the public domain on the PEDIG public website after the completion of each protocol and publication of the primary manuscript.
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Between December 2014 and May 2015, 58 children were enrolled at 21 sites, with 31 participants assigned to observation and 27 to overminus treatment.
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| ID | Title | Description |
|---|---|---|
| FG000 | Overminus Treatment | 2.50D overminus spectacles Overminus treatment: 2.50D overminus spectacles |
| FG001 | Non-overminus Treatment | spectacles without overminus or no spectacles Non-overminus treatment: spectacles without overminus or no spectacles |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Overminus Treatment | 2.50D overminus spectacles Overminus treatment: 2.50D overminus spectacles |
| BG001 | Non-overminus Treatment | spectacles without overminus or no spectacles Non-overminus treatment: spectacles without overminus or no spectacles |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Mean Distance Exotropia Control Score | At each visit, control of the exodeviation was measured at distance (6 meters) and at near (1/3 meters) using the Office Control Score* which ranges from 0 (phoria, best control) to 5 (constant exotropia, worst control). Due to the variability of single measures of control, we used a "triple control score," which is a mean of 3 measures obtained at specific time-points during a 20- to 40-minute office examination. The primary analysis was an intention-to-treat treatment group comparison of mean 8-week distance control using an analysis of covariance (ANCOVA) model which adjusted for baseline distance control. *Mohney BG, Holmes JM. An office-based scale for assessing control in intermittent exotropia. Strabismus 2006;14(3):147-50. | Posted | Mean | Standard Deviation | points on control score scale | 8 weeks |
|
Baseline to 8 weeks after randomization.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Overminus Treatment | 2.50D overminus spectacles Overminus treatment: 2.50D overminus spectacles |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Development of esodeviation | Eye disorders | Systematic Assessment | One participant had near deviation change from 12 PD exodeviation at baseline to 3 PD esodeviation at 8 weeks. During same period, exodeviation at distance changed from 20 PD to 12 PD and stereoacuity at near changed from 100 arcsec to 60 arcsec. |
Small sample size; only 8-weeks of follow up; high test-retest variability of control; some regression to the mean may be present; do not know if treatment effect would persist after overminus lenses are replaced with usual spectacle correction.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Ray Kraker, M.S.P.H., Director of PEDIG Coordinating Center | Jaeb Center for Health Research | (813) 975-8690 | rkraker@jaeb.org |
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| Non-overminus treatment | Device | spectacles without overminus or no spectacles |
|
| 8 weeks |
| Distribution of Distance Control Score at 8-week Outcome | Control of exodeviation will be assessed in the habitual correction at distance (6 meters) and near (1/3 meter) using a standardized IXT control scale. | 8 weeks |
| Distribution of Near Control Score at 8-week Outcome | Control of exodeviation will be assessed in the habitual correction at distance (6 meters) and near (1/3 meter) using a standardized IXT control scale. | 8 weeks |
| Proportion of Subjects With Distance Control Treatment Response | A comparison of the proportion of subjects showing a "treatment response," defined as an improvement of at least 1 point in distance control (mean of the 3 assessments over the exam) between enrollment and 8 weeks. | 8 weeks |
| Symptom Survey Response to Question: Has Child Looked Over His/Her Spectacles Since Enrollment? | A brief survey of symptoms that may be associated with overminus such as headaches, eye strain, and problems with spectacle wear will be administered to the parents of the subjects. Parents are asked to respond to the survey questions based on their observations of their child in the past 2 weeks. Response options are based on frequency of observations; never, rarely, sometimes, often, always, and not applicable. Survey items were derived based on expert opinion of pediatric ophthalmologists and optometrists on the study planning committee. The response options were a 5-point Likert-type scale based on frequency of observations: never = score of 0, almost never = 1, sometimes = 2, often = 3, and always = 4. | 8 weeks |
| Stereoacuity | Stereoacuity will be assessed with habitual correction using the Randot Preschool stereotest at near (performed at 40 cm). A specific level of stereoacuity is not required for eligibility. | 8 weeks |
| Distance Visual Acuity | Monocular distance visual acuity testing with the habitual correction and without cycloplegia was measured using the Amblyopia Treatment Study HOTV testing protocol on any certified visual acuity system. The treatment groups were not different with respect to 8-week control PACT at distance | 8 weeks |
| Binocular Near Visual Acuity | Binocular near visual acuity was tested in habitual correction using the ATS4 near visual acuity test. The treatment groups were not different with respect to 8-week control at near. | 8 weeks |
| Symptom Survey Response to Question: Has Your Child Had Eyestrain (Tired, Sore, or Uncomfortable Eyes)? | A brief survey of symptoms that may be associated with overminus such as headaches, eye strain, and problems with spectacle wear will be administered to the parents of the subjects. Parents are asked to respond to the survey questions based on their observations of their child in the past 2 weeks. Response options are based on frequency of observations; never, rarely, sometimes, often, always, and not applicable. Survey items were derived based on expert opinion of pediatric ophthalmologists and optometrists on the study planning committee. The response options were a 5-point Likert-type scale based on frequency of observations: never = score of 0, almost never = 1, sometimes = 2, often = 3, and always = 4. | 8 weeks |
| Symptom Survey Response to Question: Since Enrollment Has Your Child Avoided Reading or Doing Things up Close? | A brief survey of symptoms that may be associated with overminus such as headaches, eye strain, and problems with spectacle wear will be administered to the parents of the subjects. Parents are asked to respond to the survey questions based on their observations of their child in the past 2 weeks. Response options are based on frequency of observations; never, rarely, sometimes, often, always, and not applicable. Survey items were derived based on expert opinion of pediatric ophthalmologists and optometrists on the study planning committee. The response options were a 5-point Likert-type scale based on frequency of observations: never = score of 0, almost never = 1, sometimes = 2, often = 3, and always = 4. | 8 weeks |
| Symptom Survey Response to Question: Has Your Child Reported Blurry Vision? | A brief survey of symptoms that may be associated with overminus such as headaches, eye strain, and problems with spectacle wear will be administered to the parents of the subjects. Parents are asked to respond to the survey questions based on their observations of their child in the past 2 weeks. Response options are based on frequency of observations; never, rarely, sometimes, often, always, and not applicable. Survey items were derived based on expert opinion of pediatric ophthalmologists and optometrists on the study planning committee. The response options were a 5-point Likert-type scale based on frequency of observations: never = score of 0, almost never = 1, sometimes = 2, often = 3, and always = 4. | 8 weeks |
| Proportion of Subjects With Near Control Treatment Response | A comparison of the proportion of subjects showing a "treatment response," defined as an improvement of at least 1 point in near control (mean of the 3 assessments over the exam) between enrollment and 8 weeks. | 8 weeks |
| Rochester |
| Minnesota |
| 55905 |
| United States |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Age, Customized | Baseline age reflects age at randomization. The age eligibility requirement at enrollment was 3 to <7 years old. | Number | participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Number | participants |
|
| Refractive error in more myopic eye (spherical equivalent, D) | Number | participants |
|
| Accommodative convergence over accommodation (AC/A) ratio | Accommodative convergence over accommodation (AC/A) ratio calculated by taking the difference between the distance (6m) Prism Alternate Cover Test measurements with the participant wearing habitual correction and with the participant wearing -2.00D lenses over the habitual correction, and dividing the difference by 2. | Number | participants |
|
| OG001 | Non-overminus Treatment | spectacles without overminus or no spectacles Non-overminus treatment: spectacles without overminus or no spectacles |
|
|
|
| Secondary | Mean Near Exotropia Control Score | At each visit, control of the exodeviation was measured at near (1/3 meters) using the Office Control Score which ranges from 0 (phoria, best control) to 5 (constant exotropia, worst control). Due to the variability of single measures of control, we used a "triple control score," which is a mean of 3 measures obtained at specific time-points during a 20- to 40-minute office examination. The secondary analysis was an intention-to-treat treatment group comparison of mean 8-week near control using an analysis of covariance (ANCOVA) model which adjusted for baseline near control. | Posted | Mean | Standard Deviation | points on control score scale | 8 weeks |
|
|
|
|
| Secondary | Distribution of Distance Control Score at 8-week Outcome | Control of exodeviation will be assessed in the habitual correction at distance (6 meters) and near (1/3 meter) using a standardized IXT control scale. | Posted | Number | participants | 8 weeks |
|
|
|
| Secondary | Distribution of Near Control Score at 8-week Outcome | Control of exodeviation will be assessed in the habitual correction at distance (6 meters) and near (1/3 meter) using a standardized IXT control scale. | Posted | Number | participants | 8 weeks |
|
|
|
| Secondary | Proportion of Subjects With Distance Control Treatment Response | A comparison of the proportion of subjects showing a "treatment response," defined as an improvement of at least 1 point in distance control (mean of the 3 assessments over the exam) between enrollment and 8 weeks. | Posted | Number | participants | 8 weeks |
|
|
|
|
| Secondary | Symptom Survey Response to Question: Has Child Looked Over His/Her Spectacles Since Enrollment? | A brief survey of symptoms that may be associated with overminus such as headaches, eye strain, and problems with spectacle wear will be administered to the parents of the subjects. Parents are asked to respond to the survey questions based on their observations of their child in the past 2 weeks. Response options are based on frequency of observations; never, rarely, sometimes, often, always, and not applicable. Survey items were derived based on expert opinion of pediatric ophthalmologists and optometrists on the study planning committee. The response options were a 5-point Likert-type scale based on frequency of observations: never = score of 0, almost never = 1, sometimes = 2, often = 3, and always = 4. | Spectacle-related questions at follow up apply only to observation participants prescribed correction (N=10 (32%) and to all overminus group participants N=27 (100%)). | Posted | Number | participants | 8 weeks |
|
|
|
| Secondary | Stereoacuity | Stereoacuity will be assessed with habitual correction using the Randot Preschool stereotest at near (performed at 40 cm). A specific level of stereoacuity is not required for eligibility. | Posted | Mean | Standard Deviation | log arcsecond | 8 weeks |
|
|
|
| Secondary | Distance Visual Acuity | Monocular distance visual acuity testing with the habitual correction and without cycloplegia was measured using the Amblyopia Treatment Study HOTV testing protocol on any certified visual acuity system. The treatment groups were not different with respect to 8-week control PACT at distance | Posted | Mean | Standard Deviation | prism diopters | 8 weeks |
|
|
|
| Secondary | Binocular Near Visual Acuity | Binocular near visual acuity was tested in habitual correction using the ATS4 near visual acuity test. The treatment groups were not different with respect to 8-week control at near. | Posted | Mean | Standard Deviation | prism diopters | 8 weeks |
|
|
|
| Secondary | Symptom Survey Response to Question: Has Your Child Had Eyestrain (Tired, Sore, or Uncomfortable Eyes)? | A brief survey of symptoms that may be associated with overminus such as headaches, eye strain, and problems with spectacle wear will be administered to the parents of the subjects. Parents are asked to respond to the survey questions based on their observations of their child in the past 2 weeks. Response options are based on frequency of observations; never, rarely, sometimes, often, always, and not applicable. Survey items were derived based on expert opinion of pediatric ophthalmologists and optometrists on the study planning committee. The response options were a 5-point Likert-type scale based on frequency of observations: never = score of 0, almost never = 1, sometimes = 2, often = 3, and always = 4. | Posted | Number | participants | 8 weeks |
|
|
|
| Secondary | Symptom Survey Response to Question: Since Enrollment Has Your Child Avoided Reading or Doing Things up Close? | A brief survey of symptoms that may be associated with overminus such as headaches, eye strain, and problems with spectacle wear will be administered to the parents of the subjects. Parents are asked to respond to the survey questions based on their observations of their child in the past 2 weeks. Response options are based on frequency of observations; never, rarely, sometimes, often, always, and not applicable. Survey items were derived based on expert opinion of pediatric ophthalmologists and optometrists on the study planning committee. The response options were a 5-point Likert-type scale based on frequency of observations: never = score of 0, almost never = 1, sometimes = 2, often = 3, and always = 4. | Spectacle-related questions at follow up apply only to observation participants prescribed correction (N=10 (32%) and to all overminus group participants N=27 (100%)). | Posted | Number | participants | 8 weeks |
|
|
|
| Secondary | Symptom Survey Response to Question: Has Your Child Reported Blurry Vision? | A brief survey of symptoms that may be associated with overminus such as headaches, eye strain, and problems with spectacle wear will be administered to the parents of the subjects. Parents are asked to respond to the survey questions based on their observations of their child in the past 2 weeks. Response options are based on frequency of observations; never, rarely, sometimes, often, always, and not applicable. Survey items were derived based on expert opinion of pediatric ophthalmologists and optometrists on the study planning committee. The response options were a 5-point Likert-type scale based on frequency of observations: never = score of 0, almost never = 1, sometimes = 2, often = 3, and always = 4. | Posted | Number | participants | 8 weeks |
|
|
|
| Secondary | Proportion of Subjects With Near Control Treatment Response | A comparison of the proportion of subjects showing a "treatment response," defined as an improvement of at least 1 point in near control (mean of the 3 assessments over the exam) between enrollment and 8 weeks. | Posted | Number | participants | 8 weeks |
|
|
|
|
| 0 |
| 27 |
| 3 |
| 27 |
| EG001 | Non-overminus Treatment | spectacles without overminus or no spectacles Non-overminus treatment: spectacles without overminus or no spectacles | 0 | 31 | 2 | 31 |
|
| Reduction in monocular distance visual acuity >=2 lines | Eye disorders | Systematic Assessment |
|
| Reduction in binocular near visual acuity >=2 lines | Eye disorders | Systematic Assessment |
|
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| 2 to <3 |
|
| 3 to <4 |
|
| 4 to 5 |
|
| 2 to <3 |
|
| 3 to <4 |
|
| 4 to 5 |
|
| Looked over specatcles: Sometimes |
|
| Looked over specatcles: Rarely |
|
| Looked over specatcles: Never |
|
| Sometimes |
|
| Rarely |
|
| Never |
|
| Sometimes |
|
| Rarely |
|
| Never |
|
| Sometimes |
|
| Rarely |
|
| Never |
|