An Essential Exercise for Head Motion Induced Oscillopsia

Impaired visual acuity during head movement is a common issue following vestibular loss, particularly complete bilateral vestibular loss.¹The impairment results from deficiency in the vestibular ocular reflex (VOR), which stabilizes gaze during dynamic activities that involve head displacement.

Gaze stabilization is important to optimize visual acuity with driving, shopping, walking, and athletic activities. Embedded (covert) saccades during head movements are the primary compensation mechanism for a defective vestibular ocular reflex.²

Two-Target VOR Exercise

To improve gaze stabilization, we can use the Two-Target VOR exercise:^3,4

1. Use two printed targets that are legible when the head is stationary.

2. Instruct the patient to hold the targets approximately 12 inches apart and at arms length.

3. Cue the patient to move their eyes and head to a target.

4. Instruct the patient to shift their gaze to the other target followed by a rapid head movement in the same direction.

5. Repeat step 4 in the opposite direction.

The goal of this exercise is to maintain legibility of the printed target during the head movement. Variations and progressions of the exercise include:

• Placing the targets in a variety of planes

• Varying eye totarget distances

• Increasing head movement velocity

• Adding linear head movements

• Varying the direction of the head rotationto include vertical and oblique head movement

Oscillopsia Treatment Options

• Vestibular Rehabilitation Therapy (VRT): This specialized physical therapy helps improve balance and reduce symptoms by promoting vestibular compensation through exercises that enhance the brain's ability to adapt to changes in the inner ear.

• Medications:

  • Vestibular suppressants: These medications, such as meclizine or benzodiazepines, can help reduce symptoms in the short term.

  • Treating the underlying cause: If oscillopsia is due to an underlying condition like Meniere's disease or vestibular neuritis, treating that condition may alleviate symptoms.

• Surgery: In rare cases where the cause of oscillopsia is a specific structural issue within the ear or brain, surgical intervention might be considered.

• Lifestyle Modifications: Patients are advised to avoid triggers such as rapid head movements, bright lights, or environments with a lot of visual stimuli. Wearing sunglasses or hats to reduce glare and using a cane for stability can also be helpful.

• Assistive Devices: Some patients benefit from using assistive devices like prisms in glasses, which can help stabilize vision.

• Cognitive and Behavioral Therapy: In some cases, therapy to manage anxiety and improve coping strategies can be beneficial, as chronic dizziness and visual disturbances can lead to psychological stress.

Treatment plans should be individualized based on the patient's specific condition and symptoms, often requiring a multidisciplinary approach involving otolaryngologists, neurologists, physical therapists, and other healthcare professionals.

Additional gaze stabilization exercises for head motion induced oscillopsia includeVOR x1, VOR x2, Imaginary Targets, and Translation VOR.