{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T06:41:38Z","timestamp":1775889698861,"version":"3.50.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This multicenter study aimed to compare symptoms in pediatric and adolescent patients with and without concussion using the Convergence Insufficiency Symptom Survey (CISS). We further examined symptom profiles of concussed patients with and without vergence and\/or accommodation deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Children aged 8 to &amp;lt;18\u202fyears, diagnosed with concussion 4\u202fweeks to 12\u202fmonths prior and visually normal controls underwent comprehensive testing of vergence and accommodation. Participants completed the 15-item CISS, with somatic (CISS-S), performance (CISS-P), and vision (CISS-V) subscores. Mann\u2013Whitney U tests compared total CISS scores and normalized subscores between concussed and control groups, and concussed participants with and without vergence and\/or accommodative deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 66 eligible participants (34 concussed, median age 15.0 [interquartile range, IQR: 12.2\u201316.0]; 32 controls, median age 13.0 [11.0\u201314.0]), concussed individuals had substantially higher total CISS scores (median 26.0 [19.25\u201336.75] vs. 4.0 [1.0\u20137.0];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001) and higher CISS-S, CISS-P and CISS-V subscores than controls (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Within the concussion group, 76.5% (26 of 34) demonstrated vergence and\/or accommodative deficits, showing significantly higher total CISS scores (31.50 [22.25\u201338.75] vs. 19.50 [15.75\u201321.25];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.022), higher normalized CISS-V subscores (1.33 [0.75\u20132.25] vs. 0.50 [0.00\u20130.67];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.005) and CISS-P subscores [2.50 [2.05\u20133.20] vs. 1.50 [1.15\u20132.10];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.047] compared to those without such deficits. No significant difference in CISS-S (2.14 [1.61\u20132.82] vs. 1.43 [0.82\u20131.75],\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.084) was observed between concussed groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Vergence and accommodation deficits were associated with higher CISS vision and performance related subscores. Elevated symptom reporting in the somatic and performance subscores in concussed may indicate strain in the vergence and accommodative system, as evidenced by the increased subjective discomfort and difficulty during tasks like reading and near work. Concurrent assessment of vergence and accommodation alongside CISS symptom subscores may identify patients for vision rehabilitation, aimed at improving vergence and accommodation function and reducing somatic and performance-related symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2026.1799528","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T05:30:07Z","timestamp":1774416607000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating post-concussion symptom profiles using the convergence insufficiency symptom survey in a pediatric and adolescent cohort"],"prefix":"10.3389","volume":"20","author":[{"given":"Debora","family":"Ghosh","sequence":"first","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia","family":"Marusic","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer X.","family":"Haensel","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carissa H.","family":"Wu","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin E.","family":"Slinger","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neerali","family":"Vyas","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christabel A.","family":"Ameyaw Baah","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber","family":"Hu","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joellen","family":"Leonen","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlyn Y.","family":"Lew","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gayathri","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Norouzpour","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Jenewein","sequence":"additional","affiliation":[{"name":"Pennsylvania College of Optometry at Salus University","place":["Philadelphia, PA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siva","family":"Meiyeppen","sequence":"additional","affiliation":[{"name":"Pennsylvania College of Optometry at Salus University","place":["Philadelphia, PA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitchell","family":"Scheiman","sequence":"additional","affiliation":[{"name":"Pennsylvania College of Optometry at Salus University","place":["Philadelphia, PA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tawna L.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Spencer Center for Vision Research, Byers Eye Institute at Stanford University","place":["Palo Alto, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aparna","family":"Raghuram","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"109807","DOI":"10.1136\/bjsports-2025-109807","article-title":"CONCUSS randomised clinical trial of vergence\/accommodative therapy for concussion-related symptomatic convergence insufficiency","volume":"60","author":"Alvarez","year":"2025","journal-title":"Br. J. Sports Med."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.1097\/OPX.0b013e318269c8f9","article-title":"Symptoms in children with convergence insufficiency: before and after treatment","volume":"89","author":"Barnhardt","year":"2012","journal-title":"Optom. Vis. Sci."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/OPX.0000000000002237","article-title":"Scoping review: intervention for ocular motor disorders in children and adults with mild traumatic brain injury","volume":"102","author":"Chen","year":"2025","journal-title":"Optom. Vis. Sci."},{"key":"ref1101","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1097\/OPX.0000000000001443","article-title":"Treatment of Symptomatic Convergence Insufficiency in Children Enrolled in the Convergence Insufficiency Treatment Trial-Attention & Reading Trial: A Randomized Clinical Trial","volume":"96","year":"2019","journal-title":"Optom Vis Sci."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1136367","DOI":"10.3389\/fneur.2023.1136367","article-title":"A review of brain regions and associated post-concussion symptoms","volume":"14","author":"Danielli","year":"2023","journal-title":"Front. Neurol."},{"key":"ref5","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/BF00140808","article-title":"Accommodative dysfunction","volume":"55","author":"Daum","year":"1983","journal-title":"Doc. Ophthalmol."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"899","DOI":"10.15585\/mmwr.mm7233a5","article-title":"Percentage of children and adolescents aged \u226417 years who had ever received a diagnosis of concussion or brain injury, by sex and age group","volume":"72","author":"Elgaddal","year":"2023","journal-title":"QuickStats"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"37133","DOI":"10.1038\/s41598-025-21124-0","article-title":"Oculomotor dysfunction may not subside upon clinical resolution of sport related concussion","volume":"15","author":"Fenner","year":"2025","journal-title":"Sci. Rep."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1097\/OPX.0000000000000935","article-title":"Vision therapy for post-concussion vision disorders","volume":"94","author":"Gallaway","year":"2017","journal-title":"Optom. Vis. Sci."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1080\/02699052.2021.1959065","article-title":"Association between post-concussion symptoms and oculomotor deficits among adolescents","volume":"35","author":"Gowrisankaran","year":"2021","journal-title":"Brain Inj."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.annepidem.2020.11.006","article-title":"Comparing prevalence estimates of concussion\/head injury in U.S. children and adolescents in national surveys","volume":"54","author":"Haarbauer-Krupa","year":"2021","journal-title":"Ann. Epidemiol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1136\/bjsports-2012-091941","article-title":"American medical Society for Sports Medicine position statement: concussion in sport","volume":"47","author":"Harmon","year":"2013","journal-title":"Br. J. Sports Med."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3368\/aoj.65.1.99","article-title":"Is the convergence insufficiency symptom survey specific for convergence insufficiency? A prospective, randomized study","volume":"65","author":"Horan","year":"2015","journal-title":"Am. Orthopt. J."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1097\/WNO.0000000000002275","article-title":"Functional vision questionnaire detects near triad impairments in adolescent athletes with concussion history","volume":"45","author":"Leinonen","year":"2024","journal-title":"J. Neuroophthalmol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1111\/opo.13346","article-title":"Vergence and accommodation deficits in paediatric and adolescent patients during sub-acute and chronic phases of concussion recovery","volume":"44","author":"Marusic","year":"2024","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1177\/0009922815594367","article-title":"Vision diagnoses are common after concussion in adolescents","volume":"55","author":"Master","year":"2016","journal-title":"Clin. Pediatr."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.ajo.2019.04.008","article-title":"Postconcussion: receded near point of convergence is not diagnostic of convergence insufficiency","volume":"206","author":"Raghuram","year":"","journal-title":"Am. J. Ophthalmol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.visres.2018.11.007","article-title":"Self-reported visual symptoms in children with developmental dyslexia","volume":"155","author":"Raghuram","year":"","journal-title":"Vis. Res."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1097\/OPX.0b013e3181989252","article-title":"Validity of the convergence insufficiency symptom survey: a confirmatory study","volume":"86","author":"Rouse","year":"2009","journal-title":"Optom. Vis. Sci."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1703781","DOI":"10.3389\/fnins.2025.1703781","article-title":"Functional activity changes after vergence and accommodative rehabilitation of concussion-related convergence insufficiency: CONCUSS clinical trial fMRI results","volume":"19","author":"Sangoi","year":"2025","journal-title":"Front. Neurosci."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1080\/09286580701772037","article-title":"The convergence insufficiency treatment trial: design, methods, and baseline data","volume":"15","author":"Scheiman","year":"2008","journal-title":"Ophthalmic Epidemiol."},{"key":"ref21","first-page":"214","article-title":"Convergence insufficiency treatment trial - attention and Reading trial (CITT-ART): design and methods","volume":"1","author":"Scheiman","year":"2015","journal-title":"Vis. Dev. Rehabil."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1097\/OPX.0b013e31822f4d7c","article-title":"Treatment of accommodative dysfunction in children: results from a randomized clinical trial","volume":"88","author":"Scheiman","year":"2011","journal-title":"Optom. Vis. Sci."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.visres.2020.09.011","article-title":"Frequency of oculomotor disorders in adolescents 11 to 17 years of age with concussion, 4 to 12 weeks post injury","volume":"183","author":"Scheiman","year":"2021","journal-title":"Vis. Res."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"CD006768","DOI":"10.1002\/14651858.CD006768.pub3","article-title":"Interventions for convergence insufficiency: a network meta-analysis","volume":"12","author":"Scheiman","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1097\/JSM.0000000000001106","article-title":"Double vision and light sensitivity symptoms are associated with return-to-school timing after pediatric concussion","volume":"33","author":"Schmitz","year":"2023","journal-title":"Clin. J. Sport Med."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1089\/neu.2017.5117","article-title":"Concussion alters the functional brain processes of visual attention and working memory","volume":"35","author":"Shah-Basak","year":"2018","journal-title":"J. Neurotrauma"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"E30","DOI":"10.1097\/HTR.0000000000000397","article-title":"Trends in pediatric emergency department utilization for mild traumatic brain injury before and after legislation","volume":"33","author":"Singichetti","year":"2018","journal-title":"J. Head Trauma Rehabil."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1080\/02699052.2019.1658131","article-title":"The utility of the convergence insufficiency symptom survey (CISS) post-concussion","volume":"33","author":"Trbovich","year":"2019","journal-title":"Brain Inj."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1097\/WNO.0000000000000223","article-title":"Diagnostic tests for concussion: is vision part of the puzzle?","volume":"35","author":"Ventura","year":"2015","journal-title":"J. Neuroophthalmol."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1097\/OPX.0000000000002275","article-title":"Characterizing vision-related symptoms in pediatric and adolescent concussion patients with the convergence insufficiency symptom survey","volume":"102","author":"Vyas","year":"2025","journal-title":"Optom. Vis. Sci."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.visres.2021.03.002","article-title":"Vergence, accommodation, and visual tracking in children and adolescents evaluated in a multidisciplinary concussion clinic","volume":"184","author":"Wiecek","year":"2021","journal-title":"Vis. Res."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1111\/opo.70010","article-title":"Post-concussion clinical findings of oculomotor function in paediatric patients with persisting symptoms compared to healthy controls","volume":"45","author":"Wu","year":"2025","journal-title":"Ophthalmic Physiolog. Optics: J. British College of Ophthalmic Opticians (Optometrists)"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1111\/cns.12811","article-title":"Altered cortical activation and connectivity patterns for visual attention processing in young adults post-traumatic brain injury: a functional near infrared spectroscopy study","volume":"24","author":"Wu","year":"2018","journal-title":"CNS Neurosci. Ther."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.3171\/2016.1.FOCUS15612","article-title":"Pediatric sports-related traumatic brain injury in United States trauma centers","volume":"40","author":"Yue","year":"2016","journal-title":"Neurosurg. Focus"}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1799528\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T05:30:09Z","timestamp":1774416609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1799528\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":35,"alternative-id":["10.3389\/fnins.2026.1799528"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2026.1799528","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]},"article-number":"1799528"}}