Comment on: Pencil push up training compared with binocular vision training in the management of slight post operative under correction of intermittent exotropia

Dear Editor, The recent study by Song D, Pan T, Zhou L, and Jing J[1], titled “Pencil push-up training compared with binocular vision training in the management of slight post-operative under correction of intermittent exotropia,” published in the Indian Journal of Ophthalmology, provides significant insights into the field of binocular vision. Specifically, it addresses the effectiveness of pencil push-up exercises compared to binocular vision training in managing slight surgical under-correction of intermittent exotropia. However, certain issues could be addressed to increase the study’s impact on clinical practice and guide future research paths: To begin with, the study’s findings are difficult to generalize due to the small sample size and patient attrition over the follow-up period. Furthermore, the study’s six-month duration limits our understanding of the long-term efficacy and durability of the therapies.[2] Compliance monitoring, which relies on parental reporting, introduces a possible bias that could have been avoided using objective tracking methods. Furthermore, the absence of blinding among assessors raises concerns regarding the possibility of evaluation bias, which may have impacted the reported findings.[3] The study’s cohort, recruited from a single hospital, may not be representative of the entire community with intermittent exotropia. Expanding the study to include multiple locations would offer a more comprehensive picture of the therapies’ efficacy. The research also fails to examine the frequency of adverse effects associated with the training techniques. Reporting such outcomes is critical for providing a comprehensive assessment of the therapies’ safety profiles. Furthermore, the differential in intensity and frequency between the two training regimens may have significantly influenced the results. Ensuring equivalent training intensity would have resulted in a more accurate comparison of the two strategies. Finally, while the statistical procedures used are sound, a more detailed explanation of the rationale behind the tests and corrections for multiple comparisons would improve the study’s transparency and rigor. I hope these observations will contribute to the ongoing discourse and future research in this important area. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.