Patwardhan Sourabh D, Sharma Pradeep, Saxena Rohit, Khanduja Sumeet K
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
Indian J Ophthalmol. 2008 Jul-Aug;56(4):303-6. doi: 10.4103/0301-4738.39661.
Convergence insufficiency (CI) is a common binocular vision disorder. However, there is a lack of consensus regarding the treatment most appropriate for CI. The aim of the study was to investigate the treatment for CI by surveying the ophthalmologists regarding the most common treatment modalities used in India.
Four hundred questionnaires were distributed amongst ophthalmologists attending different sessions of the Delhi Ophthalmological Society annual conference held in April 2007. Two hundred and three ophthalmologists responded (response rate 50.75%). The responders included 109 private practitioners, 57 consultants attached to teaching institutes and 37 residents.
The majority of ophthalmologists (66.7%) claimed encountering > 5% outpatient department patients with CI. Pencil push-ups therapy (PPT) was the most common first line of treatment offered by ophthalmologists (79%) followed by synoptophore exercises (18%). Only 3% referred the patients to optometrists. Thirty per cent ophthalmologists claimed good results with PPT, which was significantly higher in private practitioners (35%). Only 26% ophthalmologists explained physiological diplopia to patients on a regular basis and reported significantly higher percentage of patients (46.3%) with good results. Only 12.3% ophthalmologists needed to refer > 30% patients for synoptophore exercises. For failure of PPT 86.7% considered lack of compliance as the major reason as perceived by ophthalmologists.
This survey suggested that most ophthalmic practitioners prescribed PPT as the initial treatment for CI and had satisfactory results with PPT. The majority of the practitioners did not explain to the patient about physiological diplopia. Explaining physiological diplopia may improve outcome, as perceived from the survey.
集合不足（CI）是一种常见的双眼视觉障碍。然而，对于最适合CI的治疗方法尚无共识。本研究的目的是通过调查印度眼科医生使用的最常见治疗方式来研究CI的治疗方法。
向参加2007年4月举行的德里眼科协会年会不同场次的眼科医生发放了400份问卷。203名眼科医生做出了回应（回应率为50.75%）。回应者包括109名私人执业医生、57名附属于教学机构的顾问和37名住院医生。
大多数眼科医生（66.7%）称在门诊遇到过超过5%的CI患者。铅笔上推训练法（PPT）是眼科医生提供的最常见的一线治疗方法（79%），其次是同视机训练（18%）。只有3%的医生将患者转诊给验光师。30%的眼科医生称PPT取得了良好效果，私人执业医生中的这一比例（35%）显著更高。只有26%的眼科医生定期向患者解释生理性复视，且报告称取得良好效果的患者比例显著更高（46.3%）。只有12.3%的眼科医生需要将超过30%的患者转诊进行同视机训练。对于PPT治疗失败，86.7%的医生认为眼科医生所认为的依从性差是主要原因。
本次调查表明，大多数眼科从业者将PPT作为CI的初始治疗方法，且PPT取得了令人满意的效果。大多数从业者没有向患者解释生理性复视。从调查来看，解释生理性复视可能会改善治疗效果。
