Control of intermittent exotropia with eye exercises

Intermittent exotropia is the most common type of strabismus we see in Singapore and much of Asia. This is a condition where one eye occasionally drifts outwards especially when one looking into the distance or when tired, day dreaming or unwell.

Some people with intermittent exotropia can control the drift more easily than others. In those with poor or no control, surgery is often indicated. For those with good to moderate control, doing certain eye exercises help to maintain and build up good control of eye alignment, thus avoiding surgery.

Convergence insufficiency

The exercises are also useful for patients with convergence insufficiency, a condition in which the eyes have difficulty coming together when performing near-vision tasks. This may cause eye fatigue and occasional double vision, said Dr Yvonne Ling, Senior Consultant, Paediatric Ophthalmology and Adult Strabismus Service, at the Singapore National Eye Centre (SNEC), a member of the SingHealth group, who supervised the study team.

People with strabismus have impaired stereo-vision (3D vision), resulting in poor eye –hand coordination, and may find difficulty do things like threading a needle, or playing a fast ball game. They may also want to improve their condition for cosmetic reasons.

The traditional way of doing the exercises by looking at a line drawings on cardboard cards is used in many clinics worldwide but there is a lack of compliance by patients, who complain of boredom. “Many patients who were given the cards tell us they’ve lost them. It shows how little they did the exercises,” said Ms Tan Yi Ling, Senior Orthoptist at SNEC who helped develop the mobile app.

Strabismus patients found eye exercises more interesting and convenient

The mobile app MyEyeGym offers patients eye exercises with both line and coloured pictures and animation. As most people (and many children) carry a handphone everywhere, the exercise can be done anytime and anywhere.

SNEC recruited 103 patients and gave them either the app or the traditional cards, to do eye exercises with for 10 minutes daily. Patients were to look at 2 incomplete images of the same thing (e.g. a panda) and try to merge them into a third, complete picture. After 6-8 weeks, the cards were swopped for the app and vice versa.

More than half the patients preferred the app to the cards. Three in four found the app more interesting, and 84.3 per cent found it to be more accessible and convenient than the cards.

Eye exercises that motivate

The app is available for free and can be downloaded from Google Play Store or Apple App Store. It offers a variety of 18 interesting images and animations to choose from. There are three levels of difficulty. When patients are ready to move to a higher level, they can email and will be given a password to unlock the next level.

Activity on the app is recorded and tracked under Summary Report. There is also an alarm function to remind patients to do their exercises and show up for their appointments at SNEC. These features complement the eye exercises through encouraging patients to perform the exercise, and allowing clinicians to monitor and track the patients’ progress.

The MyEyeGym app received the Allied Health Innovative Practice – GEM (Groundbreaking, Effective, Momentous) Award in February 2014 and SiTF Best Social & Community Bronze Award in October 2014.

Ref: L20