Definition

A sensory and neuromuscular anomaly of eye movement control characterized by the inability to perform effective ocular pursuits, saccades and/or fixations.

Symptoms

The symptoms and signs associated with ocular motor dysfunction are related to visually-demanding tasks. They may include, but are not limited to, the following:

1. Lack of coordination; reduced ability to visually direct and coordinate movement (781.3)
2. Loss of place and/or omission of words when reading
3. Difficulty visually tracking and/or following objects
4. Asthenopia (368.13)
5. Vertigo (780.4)
6. Motion Sickness (994.6)
7. Reduced efficiency and productivity
8. Poor attention span/easy distractibility

Diagnostic Factors

Ocular motor dysfunction is characterized by one or more of the following diagnostic findings:

1. Ocular pursuits and/or saccades below expected
2. Difficulty separating head/body and eye movements
3. Difficulty sustaining adequate ocular motor performance under demands of cognitive processing
4. Inability to sustain fixation
5. Erratic fixations
6. Abnormal postural adaptation (781.9)

NOTE: Additional testing may be appropriate as part of the differential diagnostic workup for accommodative dysfunction to rule out other concurrent medical conditions and 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
   
   The treatment of most ocular motor dysfunctions requires orthoptics/vision therapy. However, the therapy regimen may be augmented by the use of therapeutic lenses or prisms. Optometric vision therapy usually incorporates the prescription of specific treatments in order to:
    
   1. Develop accurate fixational skills
   2. Develop accurate ocular pursuits and saccades
   3. Integrate ocular motor skills with accurate motor response
   4. Integrate ocular motor skills with other sensory skills (vestibular, kinesthetic, tactile, auditory)
   5. Integrate ocular motor skills with vergence and accommodative systems
   6. Integrate ocular motor skills 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. An ocular motor dysfunction seldom occurs as an isolated condition. The most commonly encountered ocular motor dysfunction usually requires up to an additional 18 hours of office therapy in addition to therapy provided for concurrent conditions.
2. Ocular motor dysfunction complicated by associated conditions such as stroke, head trauma or other systemic conditions 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.