Convergence Insufficiency Symptom Survey Scores for Reading Versus Other Near Visual Activities in School-Age Children

Abstract

To measure the difference in Convergence Insufficiency Symptom Survey scores for reading vs favorite near visual activities. Comparative validity analysis of diagnostic tools. 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. 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). By emphasizing reading, the Convergence Insufficiency Symptom Survey score significantly overestimates near visual symptoms in children with normal binocular vision compared with symptoms causedby preferred near activities that require similar amplitudes of accommodation and convergence.