General Binocluar Vision Dysfunction

DEFINITION:

General binocular vision dysfunction is a sensory anomaly characterized by the inability to efficiently, accurately, and/or comfortably sustain binocular vision.

SIGNS AND SYMPTOMS:

The signs and symptoms associated with general binocular vision dysfunction may include, but are not limited to, the following:

1. reduced efficiency and productivity/diminished accuracy/inconsistent work product
2. diminished performance with time on task
3. diplopia (ICD: H53.2)/tendency to close or cover one eye
4. inaccurate/inconsistent depth judgment
5. pain in or around the eye (ICD: H57.11)
6. headaches (ICD: R51)
7. difficulty sustaining near visual function
8. avoidance of visually demanding tasks
9. inaccurate eye-hand coordination
10. asthenopia (ICD: H53.149)
11. transient blurred vision
12. transpositions when copying from one source document to another
13. illusory movement
14. abnormal postural adaptation/abnormal working distance (ICD: R29.3)
15. spatial disorientation
16. photophobia (ICD: H53.149)
17. inconsistent visual attention/concentration and/or awareness
18. general fatigue (ICD: R53.83)
19. dizziness/vertigo (ICD: R42); especially during/after sustained visually demanding tasks
20. motion sickness (ICD: T75.3XXA)
21. incoordination/clumsiness (ICD: R27.8)

DIAGNOSTIC FACTORS:

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

1. restricted or imbalanced fusional vergence ranges/vergence instability
2. asthenopia/vertigo/diplopia responses during/after testing
3. abnormal relationship between accommodation and vergence
4. steep forced vergence fixation disparity curve/abnormal fixation disparity
5. abnormal AC/A-CA/C relationship
6. fragile fusion exhibited in secondary and tertiary positions of gaze
7. reduced fusional recoveries/facility/flexibility
8. anomalous slow vergence adaptation

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
8. occupational/avocational goals

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 general binocular vision dysfunctions require optometric vision therapy, which incorporates the prescription of specific treatments in order to:

1. develop adequate fusional ranges, adequate fusional stability, and adequate vergence flexibility
2. enhance accommodative/convergence relationships
3. integrate binocular function with information processing
4. integrate binocular skills with accurate motor responses
5. integrate binocular skills with other sensory skills (vestibular, kinesthetic, tactile, and auditory)
6. increase visual stamina/integrate newly established skills 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 factors. 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 general binocular vision dysfunction usually requires 24 hours of office therapy.
2. General binocular vision dysfunction may require substantially more office therapy, if complicated by associated conditions such as cerebral vascular accident, head trauma, and/or other systemic conditions.

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.