Variability of angle of deviation measurements in children with intermittent exotropia

Sarah R. Hatt, David A. Leske, Laura Liebermann, Brian G. Mohney, Jonathan M. Holmes

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Background: A change in the angle of deviation is often used to monitor the change in severity of intermittent exotropia over time; nevertheless, thresholds for a clinically significant change in angle have not been determined. We analyzed variability associated with test-retest differences and short-term variability in the condition, to provide thresholds for assessing clinically significant, long-term change in angle of intermittent exotropia. Methods: Twenty-six children with intermittent exotropia (median age, 7; range, 1-13 years) underwent repeat prism and alternate cover test measures during 3 or 4 examinations (2 hours apart) over the course of a day; 95% repeatability coefficients were derived to determine test-retest differences at distance and near fixation. Results: Derived 95% repeatability coefficients at distance were 3.4 Δ (95% CI, 0.7 Δ-6.2 Δ) for angles ≤20 Δ and 7.2 Δ (95% CI, 4.4 Δ-9.9 Δ) for angles >20 Δ; at near, 6.6 Δ (95% CI, 3.7 Δ-9.6 Δ) for angles ≤20 Δ and 12.8 Δ (95% CI, 5.3 Δ-20.3 Δ) for angles >20 Δ. Conclusions: Test-retest reliability data in this study provide thresholds to help determine clinically significant change in angle of strabismus in children with intermittent exotropia. These data should facilitate evidence-based assessment of long-term change in intermittent exotropia over time.

Original languageEnglish (US)
Pages (from-to)120-124
Number of pages5
JournalJournal of AAPOS
Issue number2
StatePublished - Apr 2012
Externally publishedYes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Ophthalmology


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