{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:02:03Z","timestamp":1789704123386,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":60,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["EY011751"],"award-info":[{"award-number":["EY011751"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["EY024333"],"award-info":[{"award-number":["EY024333"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 EY010572"],"award-info":[{"award-number":["P30 EY010572"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001818","name":"Research to Prevent Blindness","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001818","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["OVS"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine whether 3\u00a0months of prescribed full\u2010time alternate patching is more effective than observation for intermittent exotropia (IXT) in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 73 children aged 3 to &lt;9\u00a0years with mean IXT distance control score (3 measures) \u22652 points (on a 0\u20135 [phoria constant tropia] scale) with at least one score \u22653, 4, or 5 (indicating spontaneous XT over 30\u2010s observation) and a distance exodeviation of 15\u201350 prism diopters (\u0394) by prism and alternate cover test (PACT), with the near deviation not exceeding the distance by\u00a0&gt;\u00a010\u0394. Children were randomly assigned to 3\u00a0months full\u2010time patching (all waking hours, 7\u00a0days per week, alternating eyes) or observation. The primary outcome was change in mean distance IXT control at 3\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline mean (SD) distance control for children assigned to full\u2010time patching (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a036) and observation (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a037) were 3.6 (0.9) and 3.6 (0.9) points; mean distance PACT was 27\u0394 (9) and 27\u0394 (8), respectively. The 3\u2010month visit was completed by 33 (92%) of 36 and 35 (95%) of 37 children assigned to full\u2010time patching and observation. Mean patching adherence was 4.1\u00a0h per day (95% CI: 2.8\u20135.5,\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a020) by participants who returned temperature sensor occlusion dose monitors and 7.4\u00a0h per day (95% CI: 5.8\u20138.9,\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a033) by review of at\u2010home calendars and interviews with parent and child. At 3\u00a0months, children in the patching group had greater improvement in mean distance control than the observation group: 0.9 (1.3) versus 0.2 (1.1) points (difference\u00a0=\u00a00.62 points, 95% CI: 0.04\u20131.20,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.04). There was also greater improvement in mean distance PACT: 6 (7) versus 2 (7) \u0394, difference\u00a0=\u00a04\u0394 (95% CI: 1\u20138,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Three months of prescribed full\u2010time alternate day patching improved distance control and magnitude of IXT in children 3\u2010&lt;9\u00a0years, despite mean adherence substantially less than the prescribed full\u2010time regimen. Future studies should evaluate the durability of treatment effects and compare patching to other treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Clinicaltrials.Gov, registered 14 July 2022, NCT05462821.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ovs2.70015","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T21:09:10Z","timestamp":1775164150000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A randomized clinical trial of full\u2010time alternate patching therapy for intermittent exotropia in children"],"prefix":"10.1002","volume":"103","author":[{"given":"Erin C.","family":"Jenewein","sequence":"first","affiliation":[{"name":"Pennsylvania College of Optometry Drexel University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Christiansen","sequence":"additional","affiliation":[{"name":"Boston Medical Center Boston University Chobanian and Avedisian School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufeng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Jaeb Center for Health Research  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6606-8230","authenticated-orcid":false,"given":"Raymond T.","family":"Kraker","sequence":"additional","affiliation":[{"name":"Jaeb Center for Health Research  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana P.","family":"Grigorian","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donny W.","family":"Suh","sequence":"additional","affiliation":[{"name":"University of California Irvine Gavin Herbert Eye Institute  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison I.","family":"Summers","sequence":"additional","affiliation":[{"name":"Oregon Health &amp; Science University Casey Eye Institute  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Han","sequence":"additional","affiliation":[{"name":"Southern California College of Optometry at Marshall B. Ketchum University  Fullerton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahram","family":"Rahmani","sequence":"additional","affiliation":[{"name":"Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie S.","family":"Connolly","sequence":"additional","affiliation":[{"name":"Indiana University School of Optometry  Bloomington Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia L.","family":"Davis","sequence":"additional","affiliation":[{"name":"Progressive Eye Care  Lisle Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer H.","family":"Fisher","sequence":"additional","affiliation":[{"name":"University of California Berkeley Herbert Wertheim School of Optometry and Vision Science  Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin F.","family":"Javed","sequence":"additional","affiliation":[{"name":"University of California Berkeley Herbert Wertheim School of Optometry and Vision Science  Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney L.","family":"Kraus","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Wilmer Eye Institute  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhi P.","family":"Kurup","sequence":"additional","affiliation":[{"name":"Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy R.","family":"Martinson","sequence":"additional","affiliation":[{"name":"Virginia Pediatric Eye Center  Virginia Beach Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan C.","family":"Ollinger","sequence":"additional","affiliation":[{"name":"Southern College of Optometry  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Tauscher","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences University of Alabama School of Medicine  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"Vricella","sequence":"additional","affiliation":[{"name":"State University of New York College of Optometry  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0082-1242","authenticated-orcid":false,"given":"Wesley T.","family":"Beaulieu","sequence":"additional","affiliation":[{"name":"Jaeb Center for Health Research  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy L.","family":"Pineles","sequence":"additional","affiliation":[{"name":"Jules Stein Institute at the University of California Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"Cotter","sequence":"additional","affiliation":[{"name":"Southern California College of Optometry at Marshall B. 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