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I read the article by Scheiman et al1 entitled “A Randomized Clinical Trial of Treatments for Convergence Insufficiency in Children” in the January 2005 issue of the ARCHIVES with great interest. I would like to congratulate Scheiman and colleagues for venturing into this area where, truly, not many randomized clinical trials have been done.
I would, however, like to raise some important issues regarding the entire study, particularly with reference to the treatment regimens. As Kushner2 has rightly pointed out, the intensive therapy that Scheiman and colleagues have provided for the treatment group is much more intensive than the therapy for home exercises. For example, a child in group 1 exercises for only a total of 15 hours (15 min/d for 12 weeks, although this could have been just 6-8.5 min/d) whereas a child in group 2 exercises for nearly 75 hours (an excess of 60 hours of the intensive office-based exercises). I also think this shows in the results.
Though Scheiman and colleagues looked for adherence to the treatment protocol, that too was only subjective (in terms of percentage), and the authors do not have any control over that. This point, as they have rightly commented, could easily be looked into once they began a treatment arm that would include office-based pencil push-ups (group 1 treatment).
Also, Kushner has pointed out that patients are not instructed to do pencil push-ups alone very commonly, and if they are instructed to do so, the pencil push-ups are supplemented by other exercises once the patients are not showing results in 4 weeks when doing pencil push-ups alone.
Finally, I would like to commend Scheiman and colleagues for undertaking the study and preparing the ground for a more rigorous randomized clinical trial that will be needed to address this issue.
Correspondence: Dr Jethani, Department of Paediatric Ophthalmology and Strabismus, Aravind Eye Hospital, 1, Annanagar, Madurai, Tamilnadu 625020, India (xethani@rediffmail.com).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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