Evaluating post-concussion symptom profiles using the convergence insufficiency symptom survey in a pediatric and adolescent cohort

Purpose 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. Methods Children aged 8 to <18 years, diagnosed with concussion 4 weeks to 12 months 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–Whitney 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. Results Among 66 eligible participants (34 concussed, median age 15.0 [interquartile range, IQR: 12.2–16.0]; 32 controls, median age 13.0 [11.0–14.0]), concussed individuals had substantially higher total CISS scores (median 26.0 [19.25–36.75] vs. 4.0 [1.0–7.0]; p < 0.0001) and higher CISS-S, CISS-P and CISS-V subscores than controls (all p < 0.001). Within the concussion group, 76.5% (26 of 34) demonstrated vergence and/or accommodative deficits, showing significantly higher total CISS scores (31.50 [22.25–38.75] vs. 19.50 [15.75–21.25]; p = 0.022), higher normalized CISS-V subscores (1.33 [0.75–2.25] vs. 0.50 [0.00–0.67]; p = 0.005) and CISS-P subscores [2.50 [2.05–3.20] vs. 1.50 [1.15–2.10]; p = 0.047] compared to those without such deficits. No significant difference in CISS-S (2.14 [1.61–2.82] vs. 1.43 [0.82–1.75], p = 0.084) was observed between concussed groups. Conclusion 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.