Clinical factors associated with impaired near stereoacuity in children and adolescents with intermittent exotropia

Purpose To investigate clinical factors associated with impaired near stereoacuity in children and adolescents with intermittent exotropia (IXT). Methods In this hospital-based cross-sectional study, 809 patients aged 3–17 years with IXT were recruited at Tianjin Eye Hospital from January 2021 to February 2022. Near stereoacuity was measured using the Titmus stereo test (impaired defined as >100 s of arc). Factors associated with impaired near stereoacuity were first examined using univariate logistic regression, followed by multivariable logistic models with stepwise adjustment for demographic and refractive-related confounders. Exploratory subgroup analyses were conducted to assess potential heterogeneity of associations across clinical subgroups. Results Impaired near stereoacuity was observed in 52.0% (421/809) of patients. In the fully adjusted multivariable model, independent risk factors included anisometropia (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.12–2.51), longer disease duration (OR = 1.06, 95% CI: 1.01–1.12), and larger deviation angles at near (OR = 1.02, 95% CI: 1.01–1.03) and distance (OR = 1.02, 95% CI: 1.01–1.04). Associations were consistent across sex, age, and refractive status subgroups. Notably, anisometropia showed a stronger association in basic-type IXT (OR = 3.35, 95% CI: 1.77–6.32). Conclusion Impaired near stereoacuity affects over half of pediatric patients with IXT and is independently linked to anisometropia, longer disease duration, and greater deviation angles. Routine assessment of near stereoacuity and refractive status is recommended to guide early intervention and management in this population.