Validity of the convergence insufficiency symptom survey: A confirmatory study

Michael Rouse, Eric Borsting, G. Lynn Mitchell, Susan A. Cotter, Marjean Kulp, Mitchell Scheiman, Carmen Barnhardt, Annette Bade, Tomohike Yamada, Michael Gallaway, Brandy Scombordi, Mark Boas, Ryan Langan, Ruth Shoge, Lily Zhu, Raymond Chu, Susan Parker, Rebecca Bridgeford, Jamie Morris, Javier VillalobosJeffrey Cooper, Audra Steiner, Marta Brunelli, Stacy Friedman, Steven Ritter, Lyndon Wong, Ida Chung, Ashley Fazarry, Rachel Coulter, Deborah Amster, Gregory Fecho, Tanya Mahaphon, Jacqueline Rodena, Mary Bartuccio, Yin Tea, Michelle Buckland, Michael Earley, Gina Gabriel, Aaron Zimmerman, Kathleen Reuter, Andrew Toole, Molly Biddle, Nancy Stevens, Kristine Hopkins, Marcela Frazier, Janene Sims, Marsha Snow, Katherine Weise, Adrienne Broadfoot, Michelle Anderson, Catherine Baldwin, Leslie Simms, Susanna Tamkins, Hilda Capo, Mark Dunbar, Craig McKeown, Arlanna Moshfeghi, Kathryn Nelson, Vicky Fischer, Adam Perlman, Ronda Singh, Eva Olivares, Ana Rosa, Nidia Rosado, Elias Silverman, David Granet, Lara Hustana, Shira Robbins, Erica Castro, Cintia Gomi, Brian G. Mohney, Jonathan Holmes, Melissa Rice, Virginia Karlsson, Becky Nielsen, Jan Sease, Tracee Shevlin, Karen Pollack, Richard Hertle, Tracy Kitts, Melanie Schray, Linda Barrett, Loraine Sinnott, Kelly Watson, Pam Wessel, Maryann Redford, Marie Diener-West, Andrew Costello, William V. Good, Ron D. Hays, Argye Hillis, Ruth Manny

Research output: Contribution to journalArticlepeer-review

102 Scopus citations


PURPOSE. The objectives of the present study were to evaluate whether investigator bias influenced the Convergence Insufficiency Symptom Survey (CISS) scores of children with normal binocular vision (NBV) in our original validation study, reevaluate the usefulness of the cutoff score of 16, and reexamine the validity of the CISS. METHODS. Six clinical sites participating in the Convergence Insufficiency Treatment Trial (CITT) enrolled 46 children 9 to <18 years with NBV. Examiners masked to the child's binocular vision status administered the CISS. The mean CISS score was compared with that from the children with NBV in the original, unmasked CISS study and also to that of the 221 symptomatic convergence insufficiency (CI) children enrolled in the CITT. RESULTS. The mean (±standard deviation) CISS score for 46 subjects with NBV was 10.4 (±8.1). This was comparable with our prior unmasked NBV study (mean = 8.1 (±6.2); p = 0.11) but was significantly different from that of the CITT CI group (mean = 29.8 ± 9.0; p < 0.001). Eighty-three percent of these NBV subjects scored <16 on the CISS, which is not statistically different from the 87.5% found in the original unmasked study (p = 0.49). CONCLUSIONS. Examiner bias did not affect the CISS scores for subjects with NBV in our prior study. The CISS continues to be a valid instrument for quantifying symptoms in 9 to <18-year-old children. These results also confirm the validity of a cut-point of ≥16 in distinguishing children with symptomatic CI from those with NBV.

Original languageEnglish (US)
Pages (from-to)357-363
Number of pages7
JournalOptometry and Vision Science
Issue number4
StatePublished - Apr 2009


  • CISS
  • Children
  • Convergence insufficiency
  • Convergence insufficiency symptom survey
  • Interviewer bias
  • Masking
  • Normal binocular vision
  • Symptoms
  • Validity

ASJC Scopus subject areas

  • Ophthalmology
  • Optometry


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