Share this article on:

Relationship Between Clinical Signs and Symptoms of Convergence Insufficiency

Bade, Annette*; Boas, Mark; Gallaway, Michael*; Mitchell, G. Lynn; Scheiman, Mitchell*; Kulp, Marjean T.§; Cotter, Susan A.§; Rouse, Michael§The CITT Study Group

doi: 10.1097/OPX.0000000000000012
Original Articles

Purpose The percentage of children who are symptomatic has been shown to increase with the number of signs of convergence insufficiency (CI). Our goal was to investigate whether there is a relationship between the severity of the clinical signs of CI and symptom level reported in children with a three-sign symptomatic CI.

Methods The Convergence Insufficiency Treatment Trial enrolled 221 children with symptomatic CI from ages 9 to 17 years. Inclusion criteria included the following three signs of CI: (1) exophoria at near at least 4Δ greater than at distance, (2) insufficient positive fusional vergence (PFV) at near, and (3) a receded near point of convergence (NPC) of 6 cm break or greater. The relationships between the severity of each sign of CI (mild, moderate, and severe) and the level of symptoms as measured by the Convergence Insufficiency Symptom Survey (CISS) at baseline were evaluated.

Results Mean CISS scores were not significantly different between mild, moderate, and severe exophoria (p = 0.60), PFV blur (p = 0.99), Sheard’s criterion (p = 0.89), or NPC break (p = 0.84). There was also no difference between the frequency of subjects scoring at mild, moderate, or severe levels on the CISS and the severity of each sign of CI. Correlations between individual clinical signs and the CISS score were very low and not statistically significant.

Conclusions Among symptomatic children with a CISS score of 16 or higher and three clinical signs of CI, there is no further association between the severity of the clinical signs and their level of symptoms.





NOVA Southeastern University College of Optometry (AB), Ft. Lauderdale, Florida; Pennsylvania College of Optometry at Salus University (MB, MG, MS), Philadelphia, Pennsylvania; Ohio State University College of Optometry (LM, MK), Columbus, Ohio; and Southern California College of Optometry (SC, MR), Fullerton, California.

Annette Bade NOVA Southeastern University College of Optometry 3200 South University Drive Ft. Lauderdale, FL 33328–2018 e-mail:

© 2013 American Academy of Optometry