Convergence Insufficiency Symptom Survey

If you or your child struggle with near oriented visual tasks, like reading/learning, writing or computer work, this free online vision test helps determine if a Developmental Vision Evaluation is needed. When answering for a child, ask the following questions exactly as written. If the child responds with “yes”, please ask “how often” and answer accordingly. Try not to give examples.

Symptom Survey

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If your results are suggestive of Convergence Insufficiency, please fill out the form below and one of our Patient Care Coordinators will be in touch to answer your questions or help schedule an evaluation for you.

Disclaimer: The questions in this survey were pulled from the American Optometric Association’s Convergence Insufficiency Symptom Survey (CISS). These questions are proven to be valid and reliable based on Borsting EJ, Rouse MW, Mitchell GL, et al and the CITT group research. This survey only attempts to analyze the symptoms of  Convergence Insufficiency and does not omit the need for a vision evaluation by a licensed optometrist. If you are struggling with a vision dysfunction, always consult your primary care optometrist or developmental optometrist.

Reference: Borsting EJ, Rouse MW, Mitchell GL, et al and the CITT group. Validity and reliability of the revised convergence insufficiency symptom survey in children. Optometry and Vision Science 2003; 80(12):832-838.