Convergence insufficiency symptom survey: A tool to evaluate convergence excess in young adults

Abstract Purpose To determine the effectiveness of the Convergence Insufficiency Symptom Survey (CISS) in evaluating visual symptoms in young adults with convergence excess (CE). Methods A cross‐sectional study was performed based on a population of optometry students. Comprehensive binocular vision tests including cover test, near point of convergence, fusional vergence and accommodative amplitude, were performed. Participants were categorised into three groups: normal binocular vision (NBV), CE and CE + accommodative insufficiency (AI) (i.e., CE + AI). The CISS was administered to each participant. An analysis of variance with Bonferroni correction was performed to compare clinical measures among the three groups. A receiver‐operating characteristic (ROC) curve was constructed to evaluate the ability of CISS to differentiate CE from the NBV population. Results A total of 181 participants were enrolled, including 96 in the NBV group, 66 in the CE group and 19 in the CE + AI group. A significant difference in CISS score was detected between the three groups ( p < 0.001). Post‐hoc tests showed significantly higher CISS scores in the CE group (16.7 ± 10.8) and the CE + AI group (19.7 ± 10.9) compared with the NBV group (12.2 ± 7.8) ( p = 0.01 and p = 0.005, respectively), with no difference between the CE and the CE + AI groups ( p = 0.52). The ROC curve showed the CISS poorly (but significantly) differentiated CE from NBV (area under the curve = 0.62, p = 0.01). The optimal cutoff value for a CISS score to differentiate CE was 16, with sensitivity and specificity of 52% and 72%, respectively. Conclusions Young adults with CE had significantly higher CISS scores than those with NBV. Although using the CISS solely for diagnosing CE is not recommended, it can be used to provide a measure of symptoms in individuals identified as having CE based on clinical measurements.