Abstract
PURPOSE: This study sought to investigate dynamic visual acuity (DVA), binocular functions, and perceptual eye position (PEP) measured via a virtual reality (VR) evaluation system in children with intermittent exotropia (IXT) at varying viewing distances. DESIGN: Retrospective, case-control observational study. METHODS: A retrospective study was conducted involving 118 children: 59 with IXT and 59 age-matched controls. Comprehensive ophthalmic assessments, including DVA, static and dynamic PEP, contour integration, and stereopsis, were performed using an intelligent VR-based visual perception platform. Testing was conducted at four viewing distances: 0.4 m, 0.7 m, 1 m, and 3 m. RESULTS: Children with IXT demonstrated significantly higher rates of monocular DVA abnormalities across all distances compared to controls (all P < 0.001). Abnormal contour integration was markedly worse in the IXT group at 1 m (52.54% vs. 28.81%; P = 0.007). Both groups exhibited the poorest DVA and contour integration at the 3 m distance. Receiver operating characteristic (ROC) curve analysis identified optimal PEP thresholds for contour integration assessment in IXT and control groups, with high sensitivity and specificity. CONCLUSIONS: VR-based testing offers a novel, sensitive tool for detecting visuomotor deficits in children with IXT, particularly at critical distances. This methodology may enhance early diagnosis and individualized treatment planning for visual function deficits in pediatric populations.