Relationships among Clinical Factors and Patient-reported Outcome Measures in Adults with Convergence Insufficiency

Ingryd J. Lorenzana, David A. Leske, Sarah R. Hatt, Trevano W. Dean, Erin C. Jenewein, Linda R. Dagi, Casey J. Beal, Yi Pang, Dashaini V. Retnasothie, Christina A. Esposito, S. A. Erzurum, Amy E. Aldrich, Eric R. Crouch, Zhuokai Li, Raymond T. Kraker, Jonathan M. Holmes, Susan A. Cotter, Ingryd J. Lorenzana, Angelyque L. Lorenzana, Silvia HanCatherine L. Heyman, Reena A. Patel, Dashaini V. Retnasothie, Sue M. Parker, Yi Pang, Huizi Yin, Elyse Nylin, Marie I. Bodack, Karen A. Kehbein, Randy C. Brafford, Erin C. Jenewein, Ruth Y. Shoge, Karen E. Pollack, Yin C. Tea, Cristina L. Law, Julie A. Tyler, Felicia Jean Timmermann, Ida X. Chung, Chunming Liu, Kimberly R. Walker, Jennifer Baker, Darren L. Hoover, Pamela A. Huston, Jonathan M. Holmes, Suzanne M. Wernimont, Christina A. Esposito, Alicia E. Feis, Tracy A. Bland, Paula A. Handford, Caitlin C. Miller, S. Ayse Erzurum, Alysa Christiansen, Amy E. Aldrich, Lauri A. Atencio, Swati Agarwal-Sinha, Casey J. Beal, Shannon Hampton, Michael X. Repka, Xiaonong Liu, Courtney Kraus, Catherine S. Choi, Michael C. Dixon, Scott A. Larson, Xiaoyan Shan, Pavlina S. Kemp, Michael F. Gallaway, Debbie L. Killion, Donny W. Suh, Carolyn X. Chamberlain, David B. Petersen, Beth A. Morrell, Aaron M. Miller, Carole L. Gray, Eric Crouch, Earl R. Crouch, Gaylord G. Ventura, Tara H. Cronin, Andrew J. Levada, Susan H. Heaton, Lisa Bohra, Susan Nicole Perzyk

Research output: Contribution to journalArticlepeer-review


SIGNIFICANCE When exploring relationships among clinical measures and patient-reported outcome measures in adults with convergence insufficiency, worse symptoms (Convergence Insufficiency Symptom Survey [CISS] score) seemed to be correlated with worse reading function domain score (Adult Strabismus-20 quality-of-life questionnaire). After treatment, improved symptoms were associated with improved reading function quality of life. PURPOSE This study aimed to explore relationships between clinical measures and patient-reported outcome measures in adults undergoing treatment for symptomatic convergence insufficiency. METHODS In a prospective multicenter observational study, we evaluated adults with symptomatic convergence insufficiency (i.e., clinical measures of near exodeviation, receded near point of convergence, reduced near positive fusional vergence; CISS score ≥21). Fifty-seven participants treated with vision therapy/exercises (n = 35) or base-in prism (n = 22) were analyzed. Spearman correlation coefficients (R) were used to assess associations among the three clinical measures and patient-reported outcome measures (CISS, Diplopia Questionnaire, four Adult Strabismus-20 quality-of-life domains) before treatment (baseline) and after 10 weeks and 1 year. Associations were interpreted to be present when the lower limit of the 95% confidence interval (CI) was moderate to strong (R ≥ 0.4). RESULTS Among multiple exploratory analyses, the only moderate to strong baseline correlation was between worse CISS and worse Adult Strabismus-20 reading function scores (R = 0.62; 95% CI, 0.43 to 0.76). Regarding change in measures with treatment, the only moderate to strong correlations were between improved CISS and improved Adult Strabismus-20 reading function scores for prism at 10 weeks (R = 0.78; 95% CI, 0.52 to 0.91) and 1 year (R = 0.85; 95% CI, 0.65 to 0.94) and for vision therapy/exercises at 1 year (R = 0.78; 95% CI, 0.57 to 0.89). CONCLUSIONS In exploratory analyses, we found positive correlations between CISS symptom scores and reading function quality-of-life scores. The absence of correlations between symptoms and individual clinical measures is consistent with clinical experience that, in convergence insufficiency, symptoms and clinical findings can be discordant.

Original languageEnglish (US)
Pages (from-to)692-701
Number of pages10
JournalOptometry and Vision Science
Issue number9
StatePublished - Sep 1 2022

ASJC Scopus subject areas

  • Ophthalmology
  • Optometry


Dive into the research topics of 'Relationships among Clinical Factors and Patient-reported Outcome Measures in Adults with Convergence Insufficiency'. Together they form a unique fingerprint.

Cite this