Effectiveness of Pencil Push-up Exercises in Patients with Convergence Insufficiency-Type Exotropia with Receded Near Point of Convergence: A Retrospective Observational Study

Purpose: To evaluate the long-term efficacy of home-based convergence exercises using pencil push-ups in adult patients with convergence insufficiency (CI)-type exotropia with receded near point of convergence (NPC). Methods: This retrospective observational study included 30 adult patients diagnosed with CI-type exotropia, who were divided into two groups based on their adherence to pencil push-up exercises: pencil push-ups group (n = 20) and noncompliant control group (n = 10). Pencil push-ups were performed four times daily (15 repetitions per session) for 6 months. The outcomes were changes in the angle of exodeviation (distance and near), NPC, and stereopsis. Measurements were taken at baseline and after 6 months. Between-group comparisons were performed using parametric statistical tests. Results: The pencil push-ups group showed significant improvement in both distance (from 24.65 ± 5.46 to 14.40 ± 5.71 prism diopters, p < 0.001) and near exodeviation (from 35.25 ± 5.36 to 23.85 ± 6.68 prism diopters, p < 0.001). NPC improved significantly from 22.6 ± 5.2 to 8.6 ± 3.1 cm (p < 0.001). In contrast, the noncompliant group showed no significant changes in either parameter. No measurable improvement in stereopsis was observed in either group. Conclusions: Consistent home-based pencil push-up exercises significantly improved convergence and reduced exodeviation in adult patients with CI-type exotropia with receded NPC. Pencil push-ups may serve as an effective first-line or adjunctive therapy, particularly in motivated patients with moderate deviations.