Definition

A category of sensory and neuromuscular anomalies characterized by the inability to efficiently utilize and/or sustain binocular vision.

Symptoms

The symptoms and signs associated with general binocular vision disorder are related to visually demanding tasks and/or making spatial judgments. They may include, but are not limited to, the following:

1. Asthenopia (eye strain) (368.13)
2. Headache (784.0)
3. Orbital pain (379.91)
4. Difficulty sustaining attention at visually demanding tasks
5. Diplopia (double vision) (368.2)
6. Abnormal postural adaptation/abnormal working distance (781.9)
7. General fatigue (780.7)
8. Inaccurate depth judgment or stereopsis
9. Dizziness after sustained task (780.4)
10. Incoordination/clumsiness (781.3)
11. Motion sickness (994.6)

Diagnostic Factors

General binocular vision dysfunction is characterized by one or more of the following diagnostic findings:

1. Restricted or imbalanced vergence ranges
2. Abnormal asthenopia/vertigo/diplopia responses during testing
3. Suppression of binocular vision (368.31)
4. Defective stereopsis (368.33)
5. Abnormal accommodative - convergence relationship
6. Steep forced vergence slope

NOTE: Additional testing may be appropriate as part of the differential diagnostic workup for general binocular vision dysfunction to rule out other concurrent medical conditions to differentiate associated visual conditions.

Therapeutic Considerations

1. Management
   
   The doctor of optometry determines appropriate diagnostic and therapeutic modalities, and frequency of evaluation and follow-up, based upon the urgency and nature of the patient’s condition and unique needs. The management of the case and duration of treatment would be affected by:
    
   1. The severity of symptoms and diagnostic factors including onset and duration of the problem
   2. Implications of patient’s general health and associated visual condition
   3. Extent of visual demands placed upon the individual
   4. Patient compliance
   5. Prior interventions
       
2. Treatment
   
   A small percentage of cases are successfully managed by prescription of therapeutic lenses or prisms. However, most general binocular vision dysfunctions require orthoptics/vision therapy. Optometric vision therapy usually incorporates the prescription of specific treatments in order to:
    
   1. Eliminate suppression
   2. Develop adequate fusional ranges
   3. Develop adequate vergence facility
   4. Normalize depth judgment and/or stereopsis
   5. Normalize accommodative/convergence relationship
   6. Integrate binocular function with information processing

Duration of Treatment

The following treatment ranges are provided as a guide for third party claims processing and review purposes. Treatment duration will depend upon the particular patient’s condition and associated circumstances. When duration of treatment beyond these ranges is required, documentation of the medical necessity for additional treatment services may be warranted.

1. The most commonly encountered general binocular vision dysfunction usually requires 28 to 36 hours of office therapy.
2. Uncomplicated general binocular vision dysfunction, characterized only by restricted vergences: up to 25 hours of office therapy.
3. General binocular vision dysfunction complicated by:
   1. suppression: up to an additional 8 hours of office therapy
   2. diminished stereopsis: up to an additional 8 hours of office therapy
   3. other diagnosed visual anomalies: may require additional office therapy
   4. associated conditions such as stroke, head trauma or other systemic conditions: may require substantially more office therapy.

Follow-up Care

At the conclusion of the active treatment regimen, periodic follow-up evaluations should be provided at appropriate intervals. Therapeutic lenses may be prescribed at the conclusion of vision therapy for maintenance of long-term stability.