Ocular Motor Dysfunction – Deficiencies of Pursuit Eye Movements

DEFINITION:

A sensorimotor anomaly of the ocular motor system that is characterized by an inability to perform accurate, effective duction or version eye movements.

SIGNS AND SYMPTOMS:

The signs and symptoms associated with ocular motor dysfunction may include, but are not limited to, the following:

1. difficulty visually tracking and/or following objects
2. loss of place, repetition, and/or omission of words and/or lines of print while reading
3. need to utilize a marker to avoid loss of place
4. transposition when copying from one source document to another
5. diminished accuracy
6. inaccurate/inconsistent work product
7. reduced efficiency and/or productivity
8. inaccurate eye-hand coordination
9. abnormal postural adaptation/abnormal working distance (ICD: 3)
10. spatial disorientation/dizziness/motion sickness (ICD: 3XXA)
11. inconsistent visual attention/concentration or distractibility while performing visually demanding tasks
12. difficulty sustaining near visual function
13. general fatigue
14. incoordination/clumsiness (ICD: 8)

DIAGNOSTIC FACTORS:

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

1. accuracy of ocular pursuits below expecteds
2. difficulty separating head/body and eye movements
3. difficulty sustaining adequate pursuit (duction or version) eye movements under cognitive demands
4. need for tactile/kinesthetic reinforcement while performing ocular motor activities
5. abnormal findings in electro-oculography studies
6. need for saccadic movements while performing pursuits at normal speed

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 ocular motor dysfunctions require optometric vision therapy which incorporates the prescription of specific treatments in order to:

1. develop accurate ocular pursuit (duction or version) skills
2. integrate pursuits with other ocular motor skills
3. integrate ocular motor skills with accurate motor responses as well as with sensory skills (vestibular, kinesthetic, tactile, and auditory)
4. integrate ocular motor skills with vergence and accommodative systems
5. integrate ocular motor 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 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. Deficiencies in pursuit eye movements seldom occur as an isolated condition. The most commonly encountered deficiencies in pursuit eye movements usually require up to an additional 12 hours of office therapy, in addition to therapy provided for concurrent
2. Deficiencies in pursuit eye movement require substantially more office therapy, if complicated by associated conditions such as head trauma, cerebral vascular accident, 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.