{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:14:59Z","timestamp":1789186499387,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2013,9,1]],"date-time":"2013-09-01T00:00:00Z","timestamp":1377993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2013,9,1]],"date-time":"2013-09-01T00:00:00Z","timestamp":1377993600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["OVS"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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\u2010sign symptomatic CI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 4\u0394 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/opx.0000000000000012","type":"journal-article","created":{"date-parts":[[2013,8,17]],"date-time":"2013-08-17T06:55:30Z","timestamp":1376722530000},"page":"988-995","source":"Crossref","is-referenced-by-count":51,"title":["Relationship Between Clinical Signs and Symptoms of Convergence Insufficiency"],"prefix":"10.1002","volume":"90","author":[{"given":"Annette","family":"Bade","sequence":"first","affiliation":[{"name":"NOVA Southeastern University College of Optometry Ft. Lauderdale Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Boas","sequence":"additional","affiliation":[{"name":"Pennsylvania College of Optometry at Salus University Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gallaway","sequence":"additional","affiliation":[{"name":"Pennsylvania College of Optometry at Salus University Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Lynn","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Ohio State University College of Optometry Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Scheiman","sequence":"additional","affiliation":[{"name":"Pennsylvania College of Optometry at Salus University Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjean T.","family":"Kulp","sequence":"additional","affiliation":[{"name":"Ohio State University College of Optometry Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"Cotter","sequence":"additional","affiliation":[{"name":"Southern California College of Optometry Fullerton California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rouse","sequence":"additional","affiliation":[{"name":"Southern California College of Optometry Fullerton California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The CITT Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,1]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/00006324-197901000-00004","article-title":"The relationship between convergence insufficiency and school achievement","volume":"56","author":"Letourneau JE","year":"1979","journal-title":"Am J Optom Physiol Opt"},{"key":"e_1_2_7_3_1","first-page":"194","article-title":"Prevalence of convergence insufficiency among elementary school children","volume":"50","author":"Letourneau J","year":"1988","journal-title":"Can J Optom"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/00006324-199909000-00022","article-title":"Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study (CIRS) group","volume":"76","author":"Rouse MW","year":"1999","journal-title":"Optom Vis Sci"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/00006324-199802000-00012","article-title":"Frequency of convergence insufficiency in optometry clinic settings. Convergence Insufficiency and Reading Study (CIRS) Group","volume":"75","author":"Rouse MW","year":"1998","journal-title":"Optom Vis Sci"},{"key":"e_1_2_7_6_1","first-page":"25","article-title":"Association of symptoms and convergence and accommodative insufficiency in school\u2010age children","volume":"74","author":"Borsting E","year":"2003","journal-title":"Optometry"},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1097\/00006324-200312000-00014","article-title":"Validity and reliability of the Revised Convergence Insufficiency Symptom Survey in children aged 9 to 18 years. The Convergence Insufficiency Treatment Trial (CITTS) Study Group","volume":"80","author":"Borsting EJ","year":"2003","journal-title":"Optom Vis Sci"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/OPX.0b013e3181989252","article-title":"Validity of the convergence insufficiency symptom survey: a confirmatory study. The Convergence Insufficiency Treatment Trial (CITTS) Study Group","volume":"86","author":"Rouse M","year":"2009","journal-title":"Optom Vis Sci"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.optm.2008.10.019","article-title":"Correlation between asthenopic symptoms and different measurements of convergence and reading comprehension and saccadic fixation eye movements","volume":"81","author":"Cohen Y","year":"2010","journal-title":"Optometry"},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1001\/archopht.126.10.1336","article-title":"Randomized clinical trial of treatments for symptomatic convergence insufficiency in children","volume":"126","author":"The Convergence Insufficiency Treatment Trial (CITTS) Study Group","year":"2008","journal-title":"Arch Ophthalmol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00006324-193001000-00001","article-title":"Zones of ocular discomfort","volume":"7","author":"Sheard C","year":"1930","journal-title":"Am J Optom"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1080\/09286580701772037","article-title":"The convergence insufficiency treatment trial: design, methods, and baseline data","volume":"15","author":"The Convergence Insufficiency Treatment Trial (CITTS) Study Group","year":"2008","journal-title":"Ophthalmic Epidemiol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"1","author":"Bland JM","year":"1986","journal-title":"Lancet"},{"key":"e_1_2_7_14_1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/00006324-194408000-00001","article-title":"The clinical aspects of accommodation and convergence","volume":"21","author":"Morgan MW","year":"1944","journal-title":"Am J Optom Arch Am Acad Optom"},{"key":"e_1_2_7_15_1","first-page":"276","article-title":"A normative study of step vergence in elementary schoolchildren","volume":"60","author":"Scheiman M","year":"1989","journal-title":"J Am Optom Assoc"},{"key":"e_1_2_7_16_1","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/00006324-199807000-00019","article-title":"Normative values for the nearpoint of convergence of elementary schoolchildren","volume":"75","author":"Hayes GJ","year":"1998","journal-title":"Optom Vis Sci"},{"key":"e_1_2_7_17_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1001\/archopht.123.1.14","article-title":"A randomized clinical trial of treatments for convergence insufficiency in children. The Convergence Insufficiency Treatment Trial (CITT) Study Group","volume":"123","author":"Scheiman M","year":"2005","journal-title":"Arch Ophthalmol"},{"key":"e_1_2_7_18_1","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1136\/bjo.2005.068197","article-title":"Randomised clinical trial of the effectiveness of base\u2010in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children. The Convergence Insufficiency Treatment Trial (CITT) Study Group","volume":"89","author":"Scheiman M","year":"2005","journal-title":"Br J Ophthalmol"},{"key":"e_1_2_7_19_1","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1097\/OPX.0b013e318269c8f9","article-title":"Symptoms in children with convergence insufficiency: before and after treatment. The Convergence Insufficiency Treatment Trial (CITT) Study Group","volume":"89","author":"Barnhardt C","year":"2012","journal-title":"Optom Vis Sci"}],"container-title":["Optometry and Vision Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/OPX.0000000000000012","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1097\/OPX.0000000000000012","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/OPX.0000000000000012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T10:12:39Z","timestamp":1774951959000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1097\/OPX.0000000000000012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9]]},"references-count":18,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2013,9]]}},"alternative-id":["10.1097\/OPX.0000000000000012"],"URL":"https:\/\/doi.org\/10.1097\/opx.0000000000000012","archive":["Portico"],"relation":{},"ISSN":["1040-5488","1538-9235"],"issn-type":[{"value":"1040-5488","type":"print"},{"value":"1538-9235","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9]]}}}