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. 2014 May;98(5):679-83.
doi: 10.1136/bjophthalmol-2013-304533. Epub 2014 Feb 14.

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

Anna M Horwood  1 , Sonia Toor, Patricia M Riddell
Affiliations
Free PMC article

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

Anna M Horwood et al. Br J Ophthalmol. 2014 May.
Free PMC article

Abstract

Aim: 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.

Methods: 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.

Results: 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).

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.

Keywords: Diagnostic Tests/Investigation; Muscles.

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Figures

Figure 1
Figure 1
The convergence insufficiency symptom survey.
Figure 2
Figure 2
Distribution of Convergence Insufficiency Symptom Survey (CISS) scores in the whole group, no convergence insufficiency (CI) and CI groups. Dotted line indicates CISS diagnostic cut-off of 21.
Figure 3
Figure 3
Receiver operating characteristic (ROC) plot of Convergence Insufficiency Symptom Survey (CISS) score in the detection of clinical convergence insufficiency using the raw CISS score and the adjusted score.
See this image and copyright information in PMC

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