Cross-cultural adaptation and validation of the Arabic convergence insufficiency symptom survey (Arab-CISS) in Saudi Arabia

Abstract

Background: Convergence insufficiency (CI) is a common binocular vision disorder characterized by difficulty maintaining close visual focus. The Convergence Insufficiency Symptom Survey (CISS) is widely used to assess the presence and severity of CI symptoms, yet its applicability across different linguistic and cultural groups requires validation. This study aimed to translate, validate, and culturally adapt the CISS for Arabic-speaking populations, focusing on a sample from Saudi Arabia. Methods: Following established guidelines for questionnaire adaptation, the CISS was translated into Arabic and back-translated to ensure accuracy. The Arab-CISS underwent rigorous validation processes, including expert review and pre-testing. A sample of 104 participants from Qassim University, aged 18–40 years, was recruited with a Best-Corrected Visual Acuity (BCVA) of 0.1 (20/25) or better in both eyes. Internal consistency was evaluated using Cronbach’s alpha, and test–retest reliability was assessed through the Intraclass Correlation Coefficient (ICC). Results: The Arab-CISS demonstrated excellent internal consistency (Cronbach’s alpha = 0.88) and test–retest reliability (ICC = 0.93, 95% confidence interval (CI): 0.69–0.97). The Bland–Altman analysis supported these findings, showing minimal mean difference between test and retest scores (−0.1 ± 1.51), indicating stable and consistent responses over time without significant bias. Conclusion: The Arab-CISS is a reliable and valid instrument for assessing CI symptoms among Arabic-speaking individuals. Its introduction is a significant step toward improving the diagnosis and management of CI in Arabic-speaking populations.