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Purpose To evaluate the adding effect of inward decentration of concave spectacle lenses (adding a prismatic effect) on angle control in cases with distance intermittent exotropia (IXT) receiving over-minus therapy.Methods Patients with myopia with IXT angles ≤25 and a Newcastle score (NCS) ≥5 were included. Patients were randomised into two groups. Group 1 received over-minus therapy. Group 2 received over-minus therapy with inward decentration of spectacle glasses to add a base out prism effect equal to one-third of the distance angle