Convergence Insufficiency Symptom Survey Score Research Articles

Self-reported visual symptoms and high visual demand activities in professional football players: a cross-sectional survey.

Vision is crucial for football players, impacting decision-making and athletic performance. Despite its global popularity, football lacks comprehensive evaluations of the impact of digital device use on ocular symptoms during high-demand activities. To gain knowledge about the time spent by football players in high visual demand activities, the symptoms associated with binocular vision dysfunction, and their relationship with sports performance. A cross-sectional observational study was conducted in 2020 using an online survey targeting football players from Portugal, England, Spain, and Saudi Arabia. The survey, distributed over 5 weeks, aimed to collect data from approximately 5,000 football players. Information on player profiles, competitive levels, vision habits, and symptoms related to binocular vision dysfunctions was collected. The Convergence Insufficiency Symptom Survey (CISS) employed a 5-point Likert scale to indicate the average frequency of each symptom. Due to non-normality, non-parametric tests were used (p < 0.05). Specifically, Mann-Whitney U, Kruskal-Wallis, Chi-square, and Spearman's rank correlation tests were used as appropriate. Analyzing male professional football players (mean age: 27.4 ± 5.0 years, 95% CI, 26.7-28.1), it was found that 38.1% of the players had been called up to the national team and 6.9% had played over 50 games. Self-rated last season's performance had a mean score of 6.5 ± 2.1 (95% CI, 6.2-6.8)(on a scale of 1 to 10). Smartphone use exceeded 1 h daily for all players, with 36.0% surpassing 4 h. Visual symptoms, notably associated with smartphone use (35.5%), were observed. Regarding the CISS score, the mean was 7.1 ± 7.7 (IC95%: 6.6 to 8.8). A weak negative correlation (rho = -0.215, p = 0.003) emerged between CISS scores and self-perceived sports performance. Football players using prescription lenses had significantly higher CISS scores (11.9 ± 10.4, 95% CI, 12.3-7.7) compared to non-users (6.2 ± 6.8, 95% CI, 7.8-5.7) (p < 0.001). This study reveals that professional football players engage in high visual demand tasks, notably on smartphones. One-third of the players link smartphone use to ocular symptoms. The Convergence Insufficiency Symptoms Survey indicates that 6.3% exhibit binocular vision dysfunction symptoms. Those with fewer ocular symptoms perceive that they have better sports performance than their counterparts.

Creating consistency in the diagnosis of convergence insufficiency: screening methods

PurposeTo determine the sensitivity of various clinical tests in the diagnosis of convergence insufficiency. MethodsA total of 254 patients were recruited with complaints consistent with convergence problems but no prior history of strabismus surgery, eye exercises, prism use, recent concussion, or other ocular or neurological diseases. Each patient completed the convergence insufficiency symptom survey (CISS), and the following data were collected: ocular alignment at distance and near, convergence and divergence fusional amplitudes at distance and near, near-point of convergence (NPC) using an accommodative target and red lens, and assessment of quality of convergence movement (QoCM) and quality of fusional movements (QoFM). The sensitivity of each clinical test was calculated. ResultsMeasurement of NPC using red lens and subjective assessment of the QoCM and QoFM were the most sensitive diagnostic tools for near symptoms consistent with convergence insufficiency: 93.3%, 98.4%, and 94.5% respectively. CISS score, convergence fusional amplitude at near, and exophoria at near had lower sensitivities: 62.9%, 46.0%, and 72.0%, respectively. Although the majority of our patients had a heterophoria or heterotropia at distance (96.8%) and/or near (98.8%), most presented with only small phorias. Furthermore, of those who had a deviation at near, only 22% had the near exophoria exceeding the distance exophoria by 10Δ. ConclusionsIn our study cohort, NPC with red lens and subjective assessment of QoCM and QoFM proved to be the most sensitive screening tools for near symptoms consistent with convergence insufficiency.

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

To determine the effectiveness of the Convergence Insufficiency Symptom Survey (CISS) in evaluating visual symptoms in young adults with convergence excess (CE). 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. 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 was16, with sensitivity and specificity of 52% and 72%, respectively. 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.

Cataract surgery is not associated with post-operative binocular vision anomalies in age-related cataract patients.

To compare the binocular vision status of patients pre- and post-cataract surgery, and to investigate the risk factors for patients who develop binocular vision anomalies post-surgery. A prospective study of patients (≥50 years) who elected to undergo bilateral cataract surgery was implemented. A comprehensive binocular vision test battery including stereopsis, ocular alignment, fusional vergence, vergence facility, near point of convergence and the Convergence Insufficiency Symptom Survey (CISS) was administered before the first surgery and at the third visit after surgery on the second eye. A detailed diagnostic classification protocol was applied to identify the presence of binocular vision anomalies pre- and post-surgery. Seventy-three participants were included at baseline, 24 (33%) of whom were diagnosed with non-strabismic binocular vision anomalies (NSBVA), mainly convergence insufficiency (18/73, 25%). Fifty-one participants completed the post-operative evaluation, 17 (33%) of whom had NSBVA pre-surgery and 13 (26%) post-surgery (p=0.48). There were a number of conversions from NSBVA to normal binocular vision and vice versa. Logistic regression showed that the adjusted odds ratio of pre-existing NSBVA diagnosis for predicting the risk of post-operative NSBVA was 6.37 (p < 0.01). There were no significant changes in most binocular vision measures post-surgery, except for a significant improvement in the CISS score (p < 0.01, Cohen's d=0.83). Binocular vision anomalies, especially convergence insufficiency, are prevalent in the age-related cataract population. Cataract surgery does not appear to be a significant risk factor for the development of new binocular vision anomalies. A pre-existing binocular vision anomaly is the main risk factor for predicting a post-operative binocular vision anomaly in this population.

Virtual reality-based vision therapy versus OBVAT in the treatment of convergence insufficiency, accommodative dysfunction: a pilot randomized controlled trial

BackgroundVirtual reality is being increasingly applied in vision therapy. However, the differences in effectiveness, optimal treatment cycle, and prognosis between virtual reality-based vision therapy and traditional therapies remain unknown. The purpose of this study was to compare the effectiveness of virtual reality-based vision therapy and office-based vergence/accommodative therapy in young adults with convergence insufficiency or accommodative dysfunction.MethodsThe patients were randomly assigned to either the virtual reality-based vision therapy group or the office-based vergence/accommodative therapy group. The vision therapy lasted 12 weeks (1 h/week) in both groups. Binocular visual functions (vergence and accommodation) were measured and a subjective questionnaire-based assessment was performed at baseline and after 6 and 12 weeks of therapy.ResultsIn total, 33 patients with convergence insufficiency and 30 with accommodative dysfunction completed the study. After 12 weeks of treatment for convergence insufficiency, the Convergence Insufficiency Symptom Survey score (F2,31 = 13.704, P < 0.001), near point of convergence (F2,31 = 21.774, P < 0.001), positive fusional vergence (F2,31 = 71.766, P < 0.001), and near horizontal phoria (F2,31 = 16.482, P < 0.001) improved significantly in both groups. Moreover, the monocular accommodative amplitude (F2,25 = 22.154, P < 0.001) and monocular accommodative facility (F2,25 = 86.164, P < 0.001) improved significantly in both groups after 12 weeks of treatment. A statistically significant difference was observed in monocular accommodative facility (F1,25 = 8.140, P = 0.009) between the two groups, but not in other vergence and accommodative functions (0.098 < P < 0.687).ConclusionVirtual reality-based vision therapy significantly improved binocular vision functions and symptoms in patients with convergence insufficiency and accommodative dysfunction, thereby suggesting its effectiveness as a new optional or additional treatment for young adults with these conditions.Trial registrationThis study was registered at the Chinese Clinical Trials Registry on 16/04/2019 (identifier: ChiCTR1900022556).

Normative Data for Parameters of Accommodation in African Schoolchildren.

The reported interracial differences in normative data for parameters of accommodation call for investigating population-specific normative values. The study investigated and presents expected data for accommodative parameters among Ghanaian children. This study aimed to determine expected values for parameters of accommodation among schoolchildren in the Central Region of Ghana. This prospective cross-sectional study used a multistage cluster sampling approach. Normal participants were asymptomatic (Convergence Insufficiency Symptom Survey score ˂16), with unaided visual acuity or best-corrected visual acuity of 0.0 or better logMAR for each eye and having no ocular disease or no manifest strabismus. Normal participants underwent push-up and minus-lens-to-blur amplitude of accommodation tests, accuracy of accommodative response (using the monocular estimation method), and monocular and binocular accommodative facility testing. A total of 1261 normal participants within ages 11 to 17 years (mean, 14.75 ± 1.53 years) met the inclusion criteria. The mean normative data for the population include push-up amplitude of accommodation (14.04 ± 2.95 D), minus-lens-to-blur amplitude of accommodation (12.33 ± 2.55 D), and accuracy of accommodative response using the monocular estimation method (0.62 ± 0.22 D), monocular accommodative facility (9.80 ± 3.20 cycles per minute), and binocular accommodative facility (9.40 ± 3.30 cycles per minute). Age-predicted linear regression equations for the amplitude of accommodation are push-up amplitude of accommodation (16.74 - 0.18 × age in years) and minus-lens-to-blur amplitude of accommodation (15.7 - 0.23 × age in years). The study provides normative data for accommodative parameters that clinicians may use with Ghanaian populations of similar ages.

Convergence insufficiency symptom survey (CISS) scores are predictive of severity and number of clinical signs of convergence insufficiency in young adult Africans

PurposeThis study aimed to investigate the correlation between convergence insufficiency symptom survey (CISS) score and the signs of convergence insufficiency (CI) and to evaluate the sensitivity and specificity of the CISS to predict CI and ametropia among young adult university students. MethodThis prospective cross-sectional clinic-based study included 300 first year university students (mean age = 21.58 (SD ± 2.2) years) who consecutively reported for eye examination. Participants were administered the CISS questionnaire and investigated for the signs of CI. Diagnosis of CI was based on presence of three or four signs. The correlation between the CISS score and the signs of CI were determined and Receiver Operation Characteristics (ROC) curves were used to evaluate sensitivity and specificity. ResultsThere were significant correlations between CISS score and the clinical signs of CI namely NPC break (rs = 0.622, p = 0.0001), NPC recovery (rs = 0.620, p = 0.0001), near exophoria (rs = 0.434, p = 0.0001), near PFV blur (rs = -0.359, p = 0.0001), near PFV break (-0.306, p = 0.0001), near PFV recovery (rs = -0.326, p = 0.0001) and gradient AC/A ratio (rs = -0.290, p = 0.0001). There was a significant positive correlation between CISS score and the number of clinical signs of CI (rs = 0.575, p-value = 0.0001). The CISS had good sensitivity (AOC = 0.882) to predict CI and poor sensitivity (AOC = 0.642) to predict ametropia. ConclusionThe CISS score is correlated with the severity and number of signs of CI in young adult Ghanaian university students. Its use in addition to clinical investigative testing may give a definitive diagnosis of symptomatic CI.

The efficacy of multifocal soft contact lenses for the alleviation of asthenopic symptoms in myopes with accommodative lag

PurposeTo evaluate the efficacy of multifocal soft contact lenses to reduce asthenopic symptoms in myopes with accommodative lag. MethodsTwenty-four myopic participants, aged 18–35 years, with mean spherical equivalent (MSE) of ≤ -0.75D, were recruited in a randomised, double-blind crossover study. All participants were existing contact lens wearer with near orthophoria or esophoria, presenting with subjective asthenopic symptoms at baseline [Convergence Insufficiency Symptom Survey (CISS) score ≥ 21] and a lag of accommodation ≥ +0.75 D. All participants were initially fitted with single vision contact lenses for a one month period. Participants were then randomly assigned 1:1 to wear low add or high add multifocal soft contact lenses for a further month. After this period, the groups were reversed. Data were collected at baseline and following one month’s wear of each lens. Change in CISS score was evaluated as the primary outcome measure, while secondary outcome measures were changes in accommodative lag and heterophoria status. ResultsBaseline CISS score was (mean ± SD) 25.04 ± 4.58. Post-intervention scores were as follows: single vision: 24.46 ± 4.59, low add: 12.17 ± 6.89, high add: 13.71 ± 7.23. Both low add and high add multifocal soft contact lens wear was associated with an improvement in CISS score compared to baseline CISS and single vision (all p < 0.01). No significant difference was found between the CISS score for the baseline CISS and single vision (p = 1.00). No significant difference was found in lag of accommodation between lens conditions (all p > 0.05), however, there was an exophoric shift in near heterophoria between single vision and both multifocal contact lenses (low add: (mean difference 1.33 Δ, p = 0.02; high add: mean difference 1.23 Δ, p = 0.02) but not between habitual spectacle or any other modality (all p > 0.05). ConclusionsThe use of multifocal soft contact lenses for a one-month period was associated with reduced severity of asthenopic symptoms in pre-presbyopic myopes with accommodative lag. Whilst improvement of symptoms does not appear to be mediated by a significant reduction in accommodative lag, changes in heterophoria may play a role in reducing asthenopic symptoms.

Are near visual signs and symptoms in multiple sclerosis compatible with convergence insufficiency?

ABSTRACT Clinical relevance Optometric management of neurodegenerative diseases is essential since visual signs, such as double vision, visual acuity reduction, or oculomotricity dysfunctions, are usually present in these subjects over the course of the disease. The present paper can guide clinicians in better managing their patients with multiple sclerosis. Background Patients with multiple sclerosis present near vision symptoms that may be related to binocular anomalies, but these symptoms have not been investigated and related to specific signs. The aim of the present study was to evaluate the binocular vision in subjects with multiple sclerosis, and to analyse if the near visual signs and symptoms observed are compatible with those found in convergence insufficiency, as occurs in other neurodegenerative diseases. Methods A total of 57 multiple sclerosis patients and 26 healthy controls were examined and classified as potentially compatible with convergence insufficiency according to the signs and symptoms. Clinical diagnosis of convergence insufficiency was established when subjects met the following criteria: NPC breakpoint more than 6 cm, PFV ≤ than 15Δ (base-out), and exophoria greater at near than at distance at least 4Δ. Convergence Insufficiency Symptom Survey (CISS) was administered to assess the symptomatology considering a score ≥16 as positive. Results According to the CISS score, 54,4% of the multiple sclerosis subjects revised showed a suspect of convergence insufficiency, with a median score of 27 (IQR 9), whereas only one subject from control group (3.8%) showed this suspect. According to the diagnostic criteria based on signs, only 15.8% of multiple sclerosis patients had a real diagnosis of convergence insufficiency. Conclusion Multiple sclerosis patients showed symptomatology compatible with convergence insufficiency, but this was not supported by the signs which showed a more esophoric tendency. The discrepancies between the signs and symptoms could be due to the questionnaire used including items that are also related to the cognitive function and other ocular abnormalities.

Application of the Convergence Insufficiency Symptom Survey in Oculomotor Dysfunction and Accommodative Insufficiency.

This study confirmed the application of the Convergence Insufficiency Symptom Survey (CISS) in distinguishing children with oculomotor dysfunction (OMD) from those with normal binocular vision (NBV) but not in distinguishing children with accommodative insufficiency (AI). The purpose of this study was to determine the application of the CISS for quantifying symptoms in children aged 9 to 18 years with AI or OMD. All participants (aged 9 to 18 years) underwent comprehensive binocular vision tests including visual acuity, cover test, near point of convergence, fusional vergence, accommodative amplitude, and the Developmental Eye Movement test to ascertain the presence of any vision conditions. According to the examination outcomes, participants were divided into four groups: NBV group, AI group, OMD group, and a group with both AI and OMD (AI-OMD). The CISS was individually administered to each participant. An ANOVA and a receiver operating characteristic curve were performed to evaluate the ability of the CISS to quantify symptoms in AI and OMD. A total of 82 participants were qualified for this study, with 18 in the NBV group, 21 in AI, 16 in OMD, and 27 in AI-OMD group. The mean CISS score was significantly different among the four groups (F = 4.19, P = .008). Post hoc tests showed significantly higher CISS scores in the OMD group than the NBV (P = .01) and the AI (P = .03) groups, but no differences were detected among other groups. Receiver operating characteristics curve showed a significant effect of the CISS score on predicting an OMD (area under curve = 0.78, P = .006). Using a CISS score of ≥15, good discrimination of OMD was obtained. Children with OMD (Developmental Eye Movement type II or IV) had higher CISS scores than ones with NBV. Using the CISS, children with AI did not report worse symptoms than children with NBV.

Binocular Accommodation and Vergence Dysfunction in Children Attending Online Classes During the COVID-19 Pandemic: Digital Eye Strain in Kids (DESK) Study-2.

To subjectively evaluate the degree of visual fatigue in children attending online classes during the coronavirus 2019 (COVID-19) pandemic and objectively evaluate accommodation and vergence dysfunction in these children. Children aged between 10 and 17 years with recent onset of asthenopia symptoms were included. Symptoms were evaluated using the Convergence Insufficiency Symptom Survey (CISS) questionnaire. A CISS score of 16 or greater was considered symptomatic. Binocular vergence and accommodation parameters were objectively evaluated. For ease of comparison, children were divided into two groups: children using digital devices for less than 4 hours/day and children using digital devices for 4 hours/day or more. A total of 46 children with a mean age of 14.47 ± 1.95 years were evaluated. The mean duration of online classes during the COVID-19 pandemic was 3.08 ± 1.68 hours/day, which is higher than before the COVID-19 pandemic (0.58 ± 0.71 hours/day, P < .00001). The mean CISS scores were 21.73 ± 12.81 for children using digital devices less than 4 hours/day and 30.34 ± 13.0 for children using digital devices for 4 hours/day or more (P = .019). Mean near exophoria (P = .03), negative fusional vergence (P = .02), negative relative accommodation (P = .057), and accommodation amplitude (P = .002) were different between the two groups. The Spearman correlation between the symptomatic CISS score and the duration of online classes showed a linear association (coefficient rs = 0.39; P = .007). In the multivariate analysis, only the duration of online classes longer than 4 hours was a significant risk factor (P = .07) for the symptomatic CISS score. Online classes longer than 4 hours were more detrimental to abnormal binocular vergence and accommodation parameters than online classes shorter than 4 hours. [J Pediatr Ophthalmol Strabismus. 2021;58(4):224-231.].

Comparison of home-based pencil push-up therapy and office-based orthoptic therapy in symptomatic patients of convergence insufficiency: a randomized controlled trial.

To assess and compare the effectiveness of home-based pencil push-up therapy (PPT) and office-based orthoptic therapy (OBOT) in patients with convergence insufficiency. In this randomized clinical trial, 176 symptomatic patients with convergence insufficiency, aged between 9 to 30years, were randomly assigned to receive 6weeks of home-based PPT (Group I) or OBOT (Group II) after determining refractive error, near point of convergence (NPC), convergence insufficiency symptom survey (CISS) score, near phoria and positive fusional vergences (PFV) at near. The participants of Group I underwent home-based PPT (pencil push-ups exercises15 minutes per day, daily for 6weeks) and those of Group II OBOT (convergence fusional exercises on synoptophore for 20min per day, 3days a week, for 6weeks) without home reinforcement. Patients were re-examined at 3 and 6weeks after initiation of treatment. NPC and CISS score were the primary and secondary outcome measures, respectively. Statistical analysis was performed with the independent samples t-test, Friedman test and the analysis of variance (ANOVA). Statistical significance was indicated by p-value < 0.05. Participants of both the groups had statistically significant improvement in NPC, CISS score, PFV and near phoria (p < 0.001), but there was no statistically significant difference between the two groups (p > 0.05). However, patients of Group II had significantly better PFV after final visit than those of Group I (p < 0.001). Home-based PPT with good suppression control and with compliance ensured by log book entries, is a simple, cheap, less time consuming and comparably effective alternative to more expensive OBOT for patients suffering from CI. CTRI registration number: REF/2016/11/012,732, Date of registration 25/04/ 2016, Retrospectively Registered.

Interventions for convergence insufficiency: a network meta-analysis.

Interventions for convergence insufficiency: a network meta-analysis.

The Effect of Eye Exercises of Acupoints on Myopia Progression: A 3-Year Cohort Report from the Beijing Myopia Progression Study.

PurposeTo investigate the impact of eye exercises of acupoints on myopic progression among Chinese urban students.MethodsThe Beijing Myopia Progression Study (BMPS) was a three-year cohort study, with 386 students (aged 6–17 years) enrolled at baseline. These students were invited to be reexamined in the years 2011, 2012, and 2013. The student’s cycloplegic refraction at each visit and the parental non-cycloplegic refraction at baseline were performed. Students were also required to complete the eye exercise of acupoints questionnaire and the convergence insufficiency symptom survey (CISS).ResultsAt the final follow-up, 226 students (57.2%) with complete refraction and eye exercises questionnaire data were enrolled in the present study. In the multivariate analysis, only students who performed the eye exercises twice or more per day had less myopic refractive change (β=0.32, p=0.04), as compared to those who performed the eye exercises less than twice per day. No significant association was found between the CISS score and the refractive change for items in the eye exercises questionnaire.ConclusionIn this study cohort, the Chinese eye exercises of acupoints had a modest effect on reducing myopic progression among Chinese urban students aged 6 to 17 years. The precise mechanism remains unclear, especially in the absence of a control group.

Unexpectedly high prevalence of asthenopia in Australian school children identified by the CISS survey tool

BackgroundTo date there have been few systematic attempts to establish the general prevalence of asthenopia in unselected populations of school-aged children. Thus, the aim of this study was to determine whether the incorporation of Borsting et al’s 2003 Revised Convergence-Insufficiency Symptom Survey (CISS) into a general school vision screening could aid in the identification of children with visual discomfort and indicate the need for further investigation.MethodsVision screening of an unselected middle school population investigated and analysed the incidence of self-reported nearwork-related visual discomfort via the CISS along with distance and near visual acuities plus non-cycloplegic autorefraction using a Shin-Nippon NVision-K 5001.ResultsOf the 384 unselected students approached in Grades 6–9, 353 participated (92.2%, mean 13.2 ± 1.4 years). The mean CISS score for the population without amblyopia and/or strabismus (96.0% of all students) was 16.8 ± 0.6, i.e., 45% of students in this cohort had CISS scores greater than one standard deviation above the mean found by Borsting et al. in 2003 during their validation study of the CISS on 9 to 18 year old children without binocular anomalies. Regression analyses indicated significantly higher (p < 0.001) mean CISS scores for the 3.2% who were hyperopes ≥ + 2.00D by non-cycloplegic autorefraction (27.7 ± 14.7) and for those who were amblyopic (24.3 ± 6.6) or strabismic (34.0 ± 9.8). The mean CISS score of 31.6 ± 9.0 for non-amblyopic/strabismic students having near vision poorer than 0.1 LogMAR was significantly higher (p < 0.001) than for those with good acuity.ConclusionThe most important finding of this study was the high incidence of asthenopia in an unselected population and that refractive status per se was not a major contributor to CISS scores. The results highlight the usefulness of the CISS questionnaire for assessment of visual discomfort in school vision screenings and the need for future exploration of near binocular vision status as a potential driver of asthenopia in school students, especially given current trends for frequent daily use of computers and handheld devices and necessarily prolonged accommodative-convergence effort at near, both at school and at home.

Psychometric assessment of the persian version of the revised convergence insufficiency symptom survey in young adults with convergence insufficiency

Purpose:To translate the Convergence Insufficiency Symptom Survey (CISS) to Persian and to assess its validity and reliability in a group of young adult Iranian patients with convergence insufficiency (CI).Methods:The questionnaire was translated in backward and forward phases. Face validity was measured using a 6-point scale (very weak, weak, moderate, good, very good, best), and a score of ≥4 for each item indicated an acceptable face validity. The content validity was assessed using three indices of relevancy, clarity, and comprehensiveness. Relevancy and clarity were checked for each item and for the whole scale using a 4-point scale (1-undesirable, 2-relatively desirable, 3-desirable, 4-completely desirable), and Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI) were calculated for the above indices. Comprehensiveness was measured at the scale level using a 4-point scale (1-incomprehensive, 2-relatively comprehensive, 3-comprehensive, 4-totally comprehensive), and S-CVI was calculated. The internal consistency and test-retest reliability were assessed using Cronbach's alpha coefficient and interclass correlation coefficient (ICC), respectively. To evaluate discriminant validity, CI was categorized into mild, moderate, and severe stages, and the mean overall CISS score was compared between these groups.Results:Thirty CI patients aged 18–34 years participated in this study. On face validity assessment, all items finally had a score of ≥4. As for relevancy and clarity, I-CVI was above 80% for all items, and S-CVI was 98.8% and 96.6%, respectively. The S-CVI was 100% for comprehensiveness. The overall Cronbach's coefficient and ICC were 0.77 and 0.95, respectively. There was a significant difference in the overall score between the three severity groups.Conclusion:The Persian CISS is a valid and reliable tool for clinical and research applications.

The effect of base‐in prism on vision‐related symptoms and clinical characteristics of young adults with convergence insufficiency; a placebo‐controlled randomised clinical trial

The aim of the present study was to evaluate the effect of base-in prism on symptoms and clinical characteristics of young adults with convergence insufficiency. In this randomised clinical trial, 64 CI patients aged 18-38years who presented to Bina Eye Hospital, Tehran, Iran between November 2018 and April 2019 were selected and randomly assigned to either prism or placebo groups. All participants underwent complete optometric examinations, including the measurement of visual acuity, objective and subjective refraction, and complete accommodative and binocular vision examinations. Clinical examinations were repeated after three months. The overall score of the Convergence Insufficiency Symptom Survey (CISS) was considered as the primary outcome measure. Secondary outcome measures included near exophoria, positive fusional vergence at near, near point of convergence, vergence facility, monocular accommodative facility, accommodative response, negative relative accommodation and accommodative convergence/accommodation (AC/A) ratio. The mean (S.D.) age of the participants was 25.5 (5.5) years and 44% of them were male. The mean CISS score was significantly lower in the prism group compared to the placebo group in the outcome examination (p<0.001). Moreover, the values of monocular accommodative facility, accommodative response, and negative relative accommodation were significantly higher in the prism group versus the placebo group (p<0.001). There was no significant difference in other parameters, including near positive fusional vergence, near point of convergence, vergence facility, and AC/A ratio between the two groups in the outcome examination (p>0.10). The base-in prism reduced symptoms in young adults with convergence insufficiency, while it had no significant effect on the near point of convergence, near positive fusional vergence, vergence facility and AC/A ratio. However, the results of this study only supports the symptomatic effectiveness of prism in the short term and further studies are needed to assess the long-term effect of prism.

The utility of the Convergence Insufficiency Symptom Survey (CISS) post-concussion

ABSTRACTBackground: The Convergence Insufficiency Symptom Survey (CISS) is being utilized as an assessment measure following concussion despite minimal research. This study explored the sensitivity and specificity of the CISS in identifying receded near point of convergence (NPC) post-concussion.Methods: Prospective study of 130 patients post-concussion aged 11–25, classified into normal NPC (n = 94) and CI (n = 36) groups (i.e., NPC >5 cm), completed the CISS, VOMS, and PCSS. Sensitivity and specificity identifying receded NPC were explored with published CISS cutoff score (>16). ROC with AUC analysis was conducted to determine an alternate CISS cutoff score to yield optimal sensitivity and specificity in patients with concussion.Results: Utilizing the published cutoff score, the CISS demonstrated adequate sensitivity (.78 [95% CI = .60-.89]) but poor specificity (.35 [95%CI = .26-.46]). ROC curve demonstrated that CISS score was significant (P = .01) in predicting a positive test result (i.e., NPC >5) with AUC of .65 (95%CI .54-.76). An alternative cutoff score (CISS>23) maximized sensitivity (.70) and specificity (.53) for identifying receded NPC.Conclusions: Both the previously published CISS cutoff and our sample-based cutoff score yielded a high rate of false positives for receded NPC. CISS scores post-concussion may help the clinician understand difficulties with visual tasks but is not a suitable diagnostic tool in this patient population.

Efficacy of Toric Contact Lenses in Fitting and Patient-Reported Outcomes in Contact Lens Wearers.

To assess whether patient-reported measures are improved with soft toric contact lenses (TCLs) compared with soft spherical contact lenses (SCLs) and whether clinical time needed to fit TCL is greater than SCL. Habitual contact lens wearers with vertexed spherical refraction +4.00 to +0.25 D or -0.50 to -9.00 D and cylinder -0.75 to -1.75 DC were randomly assigned to be binocularly fitted into a TCL or SCL, and masked to treatment assignment. Time to successful fit was recorded. After 5 days, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL-42) and modified Convergence Insufficiency Symptom Survey (CISS) were completed. After washout, subjects were fit into the alternative lens design (TCL or SCL). Outcomes were evaluated using linear mixed models for the time to fit and CISS score, generalized linear model for the successful fit, and Wilcoxon tests for the NEI-RQL-42. Sixty subjects (71.7% women, mean age [±SD] = 27.5±5.0 years) completed the study. The mean time to fit the TCL was 10.2±4.3 and 9.0±6.5 min for the SCL (least square [LS] mean difference (TCL-SCL)=1.2, P=0.22). Toric contact lens scored better than SCL in global NEI-RQL-42 score (P=0.006) and the clarity of vision (P=0.006) and satisfaction with correction subscales (P=0.006). CISS showed a 15% reduction in symptoms (LS mean difference [TCL-SCL]=-2.20, P=0.02). TCLs are a good option when trying to improve the vision of patients with low-to-moderate astigmatism given the subjective improvements in outcomes.

Combined Office-based Vergence Therapy and Home Therapy System for Convergence Insufficiency in Egyptian Children.

Background:Convergence Insufficiency (CI) is a common binocular vision disorder characterized by exophoria more at near than at far, a receded Near Point of Convergence (NPC), and decreased Positive Fusional Vergence (PFV) at near. This disorder is often associated with several symptoms that may disturb the person’s quality of life. Therefore, diagnosis and treatment of CI is a vital issue.Objectives:To compare therapeutic yield of Office Based Vision Therapy (OBVT) and combined OBVT with Home Therapy System (HTS) in patients with CI.Methods:The study included 102 patients with age range of 7-13 years. All patients underwent Convergence Insufficiency Symptom Survey (CISS) scoring, estimation of Near Point of Convergence (NPC) and determination of Positive Fusional Vergence at near (PFV) using Sheard’s criterion. Patients were randomly allocated in two groups: Group I: received Office-based Vision Therapy (OBVT) and Group II: received OBVT with home reinforcement using the Home Therapy System (HTS). At the end of 12th week of therapy; outcome was determined as Successful (all the following: CISS score of <16, NPC <6 cm and PFV >15Δ), Improved (CISS score of <16 or a 10 points-decrease and one of the following: NPC <6cm or improved by >4 cm, PFV >15Δ or increased by > 10Δ), Insufficient response (NPC <6cm or improved by >4 cm, PFV >15Δ or increased by > 10Δ) and non-responders.Results:At the end of the 12th week of therapy, the applied therapeutic polices were successful in 48 patients (47.1%), the symptoms were improved in 30 patients (29.4%), improvement was insufficient in 13 patients (12.7%) and 11 patients (10.8%) were considered as non-responders. There was significantly higher frequency of patients with improved outcome in group II (86%) compared to group I (69.2%).Conclusion:OBVT with home supplement using HTS provided a high success rate, and it seems to be superior to OBVT alone in treatment of children with convergence insufficiency after 12-week course of therapy.