Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.
Department of Ophthalmology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
BMJ Open Ophthalmol. 2024 Oct 31;9(1):e001713. doi: 10.1136/bmjophth-2024-001713.
The objective of this study is to investigate factors associated with outcomes after 3 months of instructed usage of hand-held digital devices (DD) in patients with acquired comitant esotropia (ACE).
This prospective multicentre observational study included patients with ACE, aged 5-35 years, who used DD within 1 year of onset and were followed up for clinical findings and instructed use of DD. The outcomes were classified into four groups: cured, improved, unchanged and worsened. After the analysis of group differences in the clinical and DD use-related factors by univariate analysis, we used ordinal logistic regression models to identify factors associated with favourable outcomes.
Of 156 patients (mean age (SD): 16.4 (7.4) years), 10 (6%), 58 (37%), 67 (43%) and 21 (14%) were classified into the cured, improved, unchanged, and worsened, respectively. In the univariate analysis, consultation within 3 months of onset, small-angle strabismus at distance and good stereoacuity were associated with good outcomes. Ordinal logistic regression analysis on adjusting for age with stereoacuity or successful DD-use time halving showed that small-angle strabismus at distance (OR: 1.02, 95% CI 1.00 to 1.03, p=0.023), good stereoacuity (OR: 1.31; 95% CI 1.10 to 1.56; p=0.003) and successful halving of DD-use time (OR: 0.63; 95% CI 0.43 to 0.92; p=0.016) influenced favourable outcomes.
Patients with small-angle esotropia, good stereoacuity on consultation and success in halving DD-use time had a higher chance of recovery through instructional DD usage. Further studies using objectively measurable systems are needed to ensure the accuracy of DD-use time.
本研究旨在探讨与获得性共同性内斜视（ACE）患者使用手持式数字设备（DD） 3 个月后结局相关的因素。
这是一项前瞻性多中心观察性研究，纳入了 ACE 患者，年龄在 5-35 岁之间，在发病后 1 年内使用 DD，并进行了临床发现和 DD 使用指导的随访。结局分为治愈、改善、不变和恶化 4 组。在单因素分析比较组间差异的临床和 DD 使用相关因素后，我们使用有序逻辑回归模型来确定与良好结局相关的因素。
在 156 名患者中（平均年龄（标准差）：16.4（7.4）岁），分别有 10 名（6%）、58 名（37%）、67 名（43%）和 21 名（14%）患者被分类为治愈、改善、不变和恶化。单因素分析显示，发病后 3 个月内就诊、远距离小角度斜视和良好的立体视锐度与良好结局相关。在调整年龄与立体视锐度或成功将 DD 使用时间减半的有序逻辑回归分析中，显示远距离小角度斜视（OR：1.02，95%CI 1.00 至 1.03，p=0.023）、良好的立体视锐度（OR：1.31；95%CI 1.10 至 1.56；p=0.003）和成功将 DD 使用时间减半（OR：0.63；95%CI 0.43 至 0.92；p=0.016）影响良好结局。
小角度斜视、就诊时具有良好的立体视锐度和成功将 DD 使用时间减半的患者，通过使用 DD 进行指导，恢复的机会更高。需要使用客观可测量系统的进一步研究来确保 DD 使用时间的准确性。
