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Validity and Reliability of the Revised Convergence Insufficiency Symptom Survey in Children Aged 9 to 18 Years

BORSTING, ERIC J. OD, MS, FAAO; ROUSE, MICHAEL W. OD, MS, FAAO; MITCHELL, G. LYNN MS, FAAO; SCHEIMAN, MITCHELL OD, FAAO; COTTER, SUSAN A. OD, FAAO; COOPER, JEFFREY OD, MS, FAAO; KULP, MARJEAN TAYLOR OD, MS, FAAO; LONDON, RICHARD MA, OD, FAAOand THE CONVERGENCE INSUFFICIENCY TREATMENT TRIAL GROUP

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Purpose. To assess the validity and reliability of the Convergence Insufficiency Symptom Survey (CISS) in children aged 9 to 18 years. The CISS is the primary outcome measure for a pilot study evaluating two different treatments for convergence insufficiency (CI).

Methods. Children with CI were given the CISS twice to assess reliability. CISS scores for the first administration were also compared with scores from children with normal binocular vision to assess the validity of the CISS.

Results. Forty-seven children with CI and 56 children with normal binocular vision participated in the study. Reliability was assessed using intraclass correlation and 95% limits of agreement for the children with CI. For children with CI, the intraclass correlation was 0.77 (95% confidence interval, 0.613 to 0.873), and the 95% limits of agreement were −10.2 to +12.1. The mean (±SD) CISS score was 30.8 ± 8.4 for the children with CI and 8.4 ± 6.4 for the children with normal binocular vision. These means were significantly different (p < 0.0001). Good discrimination (sensitivity, 96%; specificity, 88%) was obtained using a score of ≥16.

Conclusions. Children with CI showed a significantly higher CISS symptom score than children with normal binocular vision. The results of the study indicate that the CISS is a valid and reliable instrument to use as an outcome measure for children aged 9 to 18 who are enrolled in clinical research concerning CI.

Southern California College of Optometry, Fullerton, California (EJB, MWR, SAC), The Ohio State University College of Optometry, Columbus, Ohio (GLM, MK), Pennsylvania College of Optometry, Philadelphia, Pennsylvania (MS), State University of New York, College of Optometry, New York (JC), Pacific University College of Optometry, Forest Grove, Oregon (RL)

Received January 21, 2003;

revision received July 21, 2003.

Eric Borsting

Southern California College of Optometry

2575 Yorba Linda Blvd.

Fullerton, CA 92831

e-mail: eborsting@scco.edu

© 2003 American Academy of Optometry