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Convergence Insufficiency Symptom Survey Scores for Reading Versus Other Near Visual Activities in School-Age
Tiana Y Clark1, Robert A Clark2
1Family Eye Medical Group, Long Beach, California.
Insights
The Convergence Insufficiency Symptom Survey overestimates visual symptoms in children when focused on reading. Modifying the survey for preferred activities provides a more accurate assessment of near vision issues.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Visual Science
Background:
- Convergence insufficiency (CI) is a common cause of visual discomfort during near work.
- The Convergence Insufficiency Symptom Survey (CISS) is widely used to assess CI symptoms.
- Current CISS administration often emphasizes reading, which may not reflect real-world visual demands.
Purpose of the Study:
- To compare Symptom Survey scores for reading versus preferred near visual activities in children.
- To determine if the CISS overestimates symptoms when focused on reading.
Main Methods:
- A comparative validity analysis was conducted on diagnostic tools.
- 100 children (aged 9-18) with normal binocular vision completed either the standard reading-focused CISS or a modified CISS.
- Survey scores were compared using t tests and Mann-Whitney U tests.
Main Results:
- The reading-focused CISS yielded significantly higher scores than the modified survey (14.1 vs 6.7, P < .0001).
- Symptom scores were significantly higher for reading across all subcategories: cognitive performance, fatigue, discomfort, and impaired vision.
- Using a threshold of 16, 38% of children would be diagnosed with CI based on the reading survey, versus only 10% based on the modified survey (P = .001).
Conclusions:
- The CISS significantly overestimates near visual symptoms in children when reading is emphasized.
- Symptoms reported during reading may not accurately reflect those experienced during preferred near activities.
- Survey modifications may be necessary for a more accurate diagnosis of convergence insufficiency in pediatric populations.
Purpose:
To measure the difference in Convergence Insufficiency Symptom Survey scores for reading vs favorite near visual activities.
Design:
Comparative validity analysis of diagnostic tools.
Methods:
At a single clinical private practice, 100 children aged 9-18 with normal binocular vision were recruited to receive either the original survey emphasizing reading or a modified survey replacing "reading" with their favorite near activity. Average survey scores and subscores for questions emphasizing fatigue, discomfort, impaired vision, and cognitive performance were compared using t tests, while responses to individual questions were compared using Mann-Whitney U tests.
Results:
The average reading survey score was significantly greater than the favorite near activity survey score (14.1 ± 11.5 vs 6.7 ± 5.8, P = .0001). The largest difference resulted from questions emphasizing cognitive performance (subscore 5.8 ± 4.3 vs 2.0 ± 2.1, P = .0000002), although significant differences were also found for fatigue (5.4 ± 3.8 vs 3.0 ± 2.7, P = .0003), discomfort (3.9 ± 4.6 vs 1.8 ± 2.2, P = .004), and impaired vision (3.2 ± 3.9 vs 1.8 ± 2.2, P = .02). Significant differences were found for 7 survey questions, with higher symptom scores for the reading survey in every case. Using survey scores ≥16 to diagnose convergence insufficiency, significantly more children taking the reading survey would have been diagnosed with convergence insufficiency than children taking the favorite near activity survey (19 of 50 [38%] vs 5 of 50 [10%], P = .001).
Conclusions:
By emphasizing reading, the Convergence Insufficiency Symptom Survey score significantly overestimates near visual symptoms in children with normal binocular vision compared with symptoms caused by preferred near activities that require similar amplitudes of accommodation and convergence.
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