Screening for convergence insufficiency using the CISS is not indicated in young adults

Abstract

AimThis paper presents Convergence Insufficiency Symptom Survey (CISS) and orthoptic findings in a sample of typical young adults who considered themselves to have normal eyesight apart from weak spectacles.MethodsThe CISS questionnaire was administered, followed by a full orthoptic evaluation, to 167 university undergraduate and postgraduate students during the recruitment phase of another study. The primary criterion for recruitment to this study was that participants ‘felt they had normal eyesight’. A CISS score of ≥21 was used to define ‘significant’ symptoms, and convergence insufficiency (CI) was defined as convergence ≥8 cm from the nose with a fusion range <15Δ base-out with small or no exophoria.ResultsThe group mean CISS score was 15.4. In all, 17 (10%) of the participants were diagnosed with CI, but 11 (65%) of these did not have significant symptoms. 41 (25%) participants returned a ‘high’ CISS score of ≥21 but only 6 (15%) of these had genuine CI. Sensitivity of the CISS to detect CI in this asymptomatic sample was 38%; specificity 77%; positive predictive value 15%; and negative predictive value 92%. The area under a receiver operating characteristic curve was 0.596 (95% CI 0.46 to 0.73).Conclusions‘Visual symptoms’ are common in young adults, but often not related to any clinical defect, while true CI may be asymptomatic. This study suggests that screening for CI is not indicated.

Accommodative and binocular dysfunctions: prevalence in a randomised sample of university students

“…So, we created a specific methodology based on scientific evidence for classifying accommodative and binocular disorders using symptoms and fundamental and complementary signs. Some authors have performed similar classifications, diagnosing a disorder according to the number of clinical signs that the subject presented, mainly for convergence insufficiency, but this is not the case for other dysfunctions. Therefore, the criteria used in this study differ substantially from those criteria employed by other authors on prevalence studies, who in no case justify why they consider those clinical signs.…”

Effect of Corneal Refractive Surgery on Accommodative and Binocular Dysfunctions Among Civilian Pilots in Southwest China

“…Firstly, some professionals have argued that CI is not a highly symptomatic condition. Some subjects with CI who were not symptomatic might have suppression, avoidance of near visual tasks, or monocular occlusion [32,33], but this was not assessed directly in this study. Secondly, this study also revealed signi cantly lower accommodative amplitude and binocular accommodative facility in symptomatic subjects with CI compared with asymptomatic subjects with CI.…”

Symptomatic classic convergence insufficiency treated with dot card orthoptic exercise

“…Notwithstanding further research is warranted to investigate the effectiveness of the CISS questionnaire in screening for CI among a larger population of young African patients as a study indicates its ineffectiveness in young university adult populations' elsewhere. 19 …”