Translation and validation of convergence insufficiency symptom survey to Italian: Psychometric results

Laura Boccardo, Assunta Di Vizio, Giulia Galli, Shehzad A Naroo, Antonio Fratini, Silvia Tavazzi, Massimo Gurioli, Fabrizio Zeri

Research output: Contribution to journalArticlepeer-review


Purpose: This study aimed to translate the Convergence Insufficiency Symptom Survey (CISS) into the Italian language and assess psychometric properties of the translated questionnaire (CISS_I). Methods: The CISS_I was arranged according to guidelines for a comprehensive multistep methodologic process for translating, adapting, and validating psychometric instruments in health care research. The CISS_I questionnaire was administered to 103 volunteers (21.8 ± 2.2 years), students in higher education, at two different times. A complete optometric evaluation was performed including subjective refraction, best corrected visual acuity, near point of convergence, prism fusional ranges to blur, diplopia and recovery, TNO stereo test and prism cover test for measurement of heterophoria. Results: The performance of the CISS_I in terms of validity showed some points of weakness. Sensitivity was 42%, specificity was 74%, positive predictive value was 27% and negative predictive value was 85%. The area under the ROC curve was 0.672. On the contrary, the results showed good internal consistency of the CISS_I (Cronbach's alpha - α=0.89) and good test-retest reliability (ICC = 0.92). Rasch analysis showed good model fit (all items, except one, with infit and outfit mean square between 0.7 and 1.3), good measurement precision (person separation = 2.66) and good targeting –0,81 logits but also some evidence of multidimensionality. Conclusions: The CISS_I showed some point of weakness in terms of validity but also good psychometric properties and has been shown to be applicable to an Italian speaking population to quantify the visual discomfort associated with near vision in higher education students. The results show that high CISS_I score is not necessarily linked to convergence insufficiency, while low scores can exclude the presence of this anomaly. The CISS_I can help in interpreting and monitoring convergence insufficiency symptoms in already identified subjects, but it is not suitable for screening a general population of young adults.

Original languageEnglish
Number of pages10
JournalJournal of Optometry
Early online date4 Oct 2022
Publication statusE-pub ahead of print - 4 Oct 2022

Bibliographical note

© 2022 Spanish General Council of Optometry. Corrected Proof Published by Elsevier España, S.L.U. This is an open access article under the CC BYNC-ND license (


  • Symptom survey
  • CISS
  • Questionnaires
  • Near vision
  • Convergence insufficiency


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