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Vestibular Oculomotor Screen (VOMS)

This is an excerpt from Special Tests in Orthopedics by Tamara C Valovich McLeod,Sandra J Shultz.

Other names for test: None

Used to assess: Oculomotor and vestibular function

Patient position: Seated on a treatment table

Clinician position: Seated or standing in front of the patient

Clinician’s stabilizing hand position: N/A

Clinician’s test hand position: Varies by subtest

Action performed: The clinician first obtains pretest symptom scores for headache, dizziness, nausea, and fogginess. The following tests are performed, and symptom scores are reassessed following each one.

Smooth pursuits: The clinician holds a fingertip, pen, or tongue depressor at a distance of 3 ft from the patient. The patient is instructed to maintain focus on the target as the examiner moves the target smoothly in the horizontal direction 1.5 ft to the right and 1.5 ft to the left of midline. One repetition is complete when the target moves back and forth to the starting position, and two repetitions are performed. The target should be moved at a rate requiring approximately 2 s to go fully from left to right and 2 s to go fully from right to left. The test is repeated with the examiner moving the target smoothly and slowly in the vertical direction 1.5 ft above and 1.5 ft below midline for two complete repetitions up and down. Again, the target should be moved at a rate requiring approximately 2 s to move the eyes fully upward and 2 s to move fully downward.

Horizontal saccades: The clinician holds two single points (fingertips, pens, or tongue depressors) horizontally at a distance of 3 ft from the patient, and 1.5 ft. to the right and 1.5 ft to the left of midline so that the patient must gaze 30° to the left and 30° to the right. The clinician instructs the patient to move their eyes as quickly as possible from point to point. One repetition is complete when the eyes move back and forth to the starting position, and 10 repetitions are performed.

Vertical saccades: Repeat the test with two points held vertically at a distance of 3 ft from the patient, and 1.5 ft above and 1.5 ft below (hiddenfrom view) midline so that the patient must gaze 30° upward and 30° downward. The clinician instructs the patient to move their eyes as quickly as possible from point to point. One repetition is complete when the eyes move up and down to the starting position, and 10 repetitions are performed

Convergence: The patient is seated and wearing corrective lenses (if needed). The examiner is seated front of the patient and observes their eye movement during this test. The patient focuses on a small target (approximately 14-point font size) at arm’s length and slowly brings it toward the tip of their nose. The patient is instructed to stop moving the target when they see two distinct images or when the examiner observes an outward deviation of one eye. Blurring of the image is ignored. The distance in centimeters between the target and the tip of nose is measured and recorded. This is repeated a total of three times with measures recorded each time. Record headache, dizziness, nausea, and fogginess ratings after the test. Abnormal: Near point of convergence ≥ 6 cm from the tip of the nose.

Horizontal vestibular-ocular reflex: The patient holds a target of approximately 14-point font size in front of the patient in midline at a distance of 3 ft. The patient is asked to rotate their head horizontally while maintaining focus on the target. The head is moved at an amplitude of 20° to each side, and a metronome is used to ensure the speed of rotation is maintained at 180 beats per minute (one beat in each direction). One repetition is complete when the head moves back and forth to the starting position, and 10 repetitions are performed. Record headache, dizziness, nausea, and fogginess ratings 10 s after the test is completed.

Vertical vestibular-ocular reflex: The test is repeated with the patient moving their head vertically. The head is moved in an amplitude of 20° up and 20° down, and a metronome is used to ensure the speed of movement is maintained at 180 beats per minute (one beat in each direction). One repetition is complete when the head moves up and down to the starting position, and 10 repetitions are performed. Record headache, dizziness, nausea, and fogginess ratings after the test.

Visual motion sensitivity: The patient stands, facing a busy area of the clinic. The clinician stands next to and slightly behind the patient, so that the patient is guarded but the movement can be performed freely. The patient holds their arms outstretched and focuses on their thumb. Maintaining focus on their thumb, the patient rotates, together as a unit, their head, eyes, and trunk at an amplitude of 80° to the right and 80° to the left. A metronome is used to ensure the speed of rotation is maintained at 50 beats per min (one beat in each direction). One repetition is complete when the trunk rotates back and forth to the starting position, and five repetitions are performed.

Positive result: Abnormal eye movement or symptom provocation

Accuracy: SN = .58-.96 SP = .46-.92 +LR = N/A −LR = N/A

Mucha et al. 2014; Thomas et al. 2023

Tests reprinted by permission from A. Mucha, M.W. Collins, R.J. Elbin, et al., “A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions: Preliminary Findings,” American Journal of Sports Medicine 42, no. 10 (2014): 2479-86, doi: 10.1177/0363546514543775. Reprinted by Permission of Sage Publications.

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