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FAQs
Convergence Insufficiency Symptom Survey
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1. Do your eyes feel tired when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
2. Do your eyes feel uncomfortable when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
3. Do you have headaches when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
4. Do you feel sleepy when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
5. Do you lose concentration when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
6. Do you have trouble remembering what you have read?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
7. Do you have double vision when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
8. Do you see the words move, jump, swim, or appear to float on the page when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
9. Do you feel like you read slowly?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
10. Do your eyes ever hurt when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
11. Do your eyes ever feel sore when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
12. Do you feel a 'pulling' feeling around your eyes when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
13. Do you notice the words blurring or coming in and out of focus when reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
14. Do you lose your place while reading or doing close work?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
15. Do you have to re-read the same line of words when reading?
Never
Infrequently / Not very often
Sometimes
Fairly often
Always
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