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

Horwood A, Toor S, Riddell P. Brit J Ophthalmol February 2014 DOI 10.1136/bjophthalmol-2013-304533

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    • The Convergence Insufficiency Symptom Survey would have poor sensitivity and specificity if used as a screening tool


This 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.


The 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.


The 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).


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.