Accommodative Dysfunction

ICD-10-CM: H52.523: Accommodation Disorder (Insufficiency)
H52.533: Accommodative Spasm

DEFINITION:

A non-presbyopic, non-refractive sensorimotor anomaly of the visual system characterized by inadequate accommodative accuracy and/or stability, reduced accommodative facility and/or flexibility, reduced amplitude of accommodation, inadequate sustenance of accommodation, inertia of accommodation, or accommodative spasm.

SIGNS AND SYMPTOMS:

The signs and symptoms associated with accommodative dysfunction are related to performance of prolonged visually demanding near-centered tasks. They may include, but are not limited to, the following:

1. transient blurred vision (ICD: H53.8)
2. diminished accuracy
3. abnormal postural adaptation/working distance (ICD: R29.3)
4. inconsistent work product
5. reduced efficiency and productivity
6. diminished performance with time on task/difficulty sustaining near visual function
7. difficulty shifting focus from one distance to another
8. asthenopia (ICD: H53.149)
9. pain in or around the eye (ICD: H57.13)
10. headaches (ICD: R51)
11. avoidance of visually demanding tasks
12. distance blur after performing near work
13. inconsistent visual attention/concentration or distractibility while performing visually demanding tasks
14. general fatigue (ICD: R53.83)
15. illusory movement (ICD: H53.10)

DIAGNOSTIC FACTORS:

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

1. low accommodative amplitude relative to age
2. reduced accommodative facility (monocular)
3. reduced accommodative flexibility
4. reduced accommodative stability
5. reduced ranges of relative accommodation
6. abnormal lag of accommodation
7. unstable accommodative, refractive and retinoscopic findings
8. inconsistent vergence findings

THERAPEUTIC MANAGEMENT CONSIDERATIONS:

The doctor of optometry determines appropriate diagnostic and therapeutic modalities, and frequency of evaluation and follow-up, based on the urgency and nature of the patient’s conditions and unique needs. Vision disorders that are not totally cured through vision therapy may still be ameliorated with significant improvement in visual function and quality of life. 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. the complications of associated visual conditions
3. implications of patient’s general health, cognitive development, physical development, and effects of medications taken
4. etiological factors
5. extent of visual demands placed upon the individual
6. patient compliance and involvement in the prescribed therapy regimen
7. type, scope, and results of prior interventions

PRESCRIBED TREATMENT REGIMEN:

The goal of the prescribed treatment regimen is to address the diagnostic factors and alleviate the presenting signs and symptoms associated with the diagnosed condition. Most accommodative dysfunctions require optometric vision therapy which incorporates the prescription of specific treatments in order to:

1. enhance accommodative amplitudes relative to age
2. enhance ability to sustain accommodation
3. enhance relative ranges of accommodation
4. enhance accommodative facility, flexibility and stability relative to age
5. integrate accommodation with ocular motor skills
6. enhance accommodative/convergence relationship
7. integrate accommodative function with information processing

DURATION OF TREATMENT:

The following treatment ranges are provided as a guide. 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 for third-party claims processing and review purposes.

1. The most commonly encountered accommodative dysfunction usually requires 16 hours of office therapy in addition to therapy provided for concurrent conditions.
2. Accommodative dysfunction may require substantially more office therapy, if complicated by associated conditions such as cerebral vascular accident, head trauma, and/or other systemic

FOLLOW-UP CARE:

At the conclusion of the active treatment regimen, periodic follow-up evaluation is required. Should signs, symptoms, or other diagnostic factors recur, further therapy may be medically necessary. Therapeutic lenses may be prescribed during or at the conclusion of active vision therapy to assist in the maintenance of long-term stability.