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 Functional 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

Do your eyes feel tired when reading or doing close work?
Do your eyes feel uncomfortable when reading or doing close work?
Do you have headaches when reading or doing close work?
Do you feel sleepy when reading or doing close work?
Do you lose concentration when reading or doing close work?
Do you have trouble remembering what you have read?
Do you have double vision when reading or doing close work?
Do you see the words move, jump, swim or appear to float on the page when reading or doing close work?
Do you feel like you read slowly?
Do your eyes ever hurt when reading or doing close work?
Do your eyes ever feel sore when reading or doing close work?
Do you feel a “pulling” feeling around your eyes when reading or doing close work?
Do you notice the words blurring or coming in and out of focus when reading or doing close work?
Do you lose your place while reading or doing close work?
Do you have to re-read the same line of words when reading?

A score of 16 or higher is suggestive of Convergence Insufficiency, and we recommend scheduling a complimentary consultation. A score of 21 or more suggests it is highly likely there is moderate to severe Convergence Insufficiency.


Get In Touch

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.

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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.