My Story (Full Version)
Physical Health
*Please note that this is not medical advice. Everything I write about are things I have learned and have come across in my journey in searching for answers to my own health problems. They are simply meant to be ideas to consider and to potentially look into. Please do your own research, take everything with a grain of salt, and always consult a qualified professional for help.
Binocular Vision Disorder (BVD), Vertical Heterophoria (VH), and Prism Glasses
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What is Binocular Vision Dysfunction?
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History of Binocular Vision Dysfunction
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Binocular Vision Dysfunction Symptoms
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How does Binocular Vision Dysfunction Affect Patients?
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Binocular Vision Dysfunction Patient Profile
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Where Is The Closest Binocular Vision Doctor Near Me?
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Binocular Vision Dysfunction Causes
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Binocular Vision Dysfunction Treatment
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Binocular Vision Dysfunction Test
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Binocular Vision Dysfunction and Prism Glasses
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Prism Glasses Versus Other Treatments
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Outlook
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Is BVD the Cause or the Effect?
Written By Alan
Do you experience headaches of any type, dizziness, anxiety, nausea, and other symptoms? Is there a visual component- such as light sensitivity, difficulty reading, words shimmering on a page, issues with screens, difficulty in crowds- that makes your symptoms worse? If so, Binocular Vision Dysfunction (BVD) and prism glasses might be able to help you tremendously.
In this article, I will explain the symptoms of BVD, the treatment, as well as everything you will need to know as a prospective patient. It's everything I learned from my experience as a patient, and I hope it will be able to provide some helpful insight to you.
Overview of Binocular Vision Dysfunction
Binocular Vision Dysfunction (formerly known as Vertical Heterophoria or VH) is probably one of the most important conditions you have never heard of when it comes to dealing with chronic headaches, dizziness, anxiety, and other symptoms. It is important because of its prevalence, how few people know of it, and the ease in which it can be treated. There is a very good chance that you or someone you know may be affected by this condition.
Binocular Vision Dysfunction (also known as BVD) is a condition where there is typically a vertical misalignment of the eyes, although the condition includes horizontal misalignment of the eyes as well. Vertical Heterophoria refers primarily to a vertical misalignment only. Superior Oblique Palsy is a similar condition, but only one eye is misaligned, whereas both eyes are misaligned with Binocular Vision Dysfunction. For simplicity’s sake, we will just use BVD as the blanket term.
Binocular Vision Dysfunction affects far more than just vision, and includes a plethora of symptoms that mimic much more serious conditions and diseases. The most alarming part is that your ophthalmologist and optometrist will not detect this condition with standard checkups and tests because the condition is virtually unknown of outside the handful of doctors who treat this condition. The good news is that the condition can be treated non invasively, safely, and with a high success rate when under the care of a proper doctor. The treatment is deceptively simple: a pair of glasses with prisms.
History of Binocular Vision Dysfunction (and Vertical Heterophoria)
The symptoms of Binocular Vision Dysfunction (and Vertical Heterophoria) have been mentioned in the medical literature as far back as the 1880’s, although no effective treatment was ever discovered until recently. The form of BVD written about in this article is based on the work of Dr. Debby Feinberg O.D.- of Bloomfield Hills, Michigan- whom I was a patient of. Dr. Debby is a pioneer in this field, and it has become her life’s work. Dr. Debby has provided care to patients over the past two plus decades, and has treated over 8,000 patients with this condition to date.
Binocular Vision Dysfunction Symptoms
The symptoms are far reaching and usually mimic those of much more serious and life threatening conditions, and most are neurological in nature. Because most of the symptoms are nonspecific, many people go many years and even their whole lifetimes without ever finding the answer to their problems. Most patients will have completely worked their way through the medical community before being properly diagnosed with BVD.
The symptom of BVD includes:
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Headaches- all varieties including Migraines, Tension Headaches, and Cluster Headaches
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Dizziness- of all varieties including Vertigo and Ataxia
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Anxiety
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Feeling overwhelmed in crowds or public spaces
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Eyestrain
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Discomfort from visual activities and light sensitivity
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Blurred or double vision
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A feeling as if words or images are shimmering
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Feeling as if things are moving visually when they are not
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Unsteadiness
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Chronic tilting of the head to one side
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Neck pain and neck aches
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Facial Pain
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Nausea and motion sickness
More painful than the symptoms themselves however, are the countless number of patients who have been told there is nothing wrong with them, they are seeking medication, or that they are just plain crazy. This is simply not true. The symptoms of BVD are very real.
If you believe you may be living with BVD, you there is a simple questionnaire which can help determine if prism glasses can help you. Locate the closest BVD doctor to you and check our their site for more info. There is also a simple 5 minute test that can help determine if you have BVD.
How Does Binocular Vision Dysfunction Affect a Patient?
In order to understand how BVD and Vertical Heterophoria affects a person, it is important to first have a basic idea of how the eyes and vision work. When most people look around, the world they see is three dimensional with everything appearing as one. In reality, they are actually seeing two exact images of everything superimposed on top of each other. When the eyes are in perfect alignment, one image is taken from the left eye and another taken from the right eye. These two images are then fed simultaneously and seamlessly to the brain giving the illusion that there is only one image.
For a person with BVD however, there is a vertical, horizontal, or combined vertical and horizontal misalignment of the eyes. Much like a normal person, one image is taken from the left eye and one from the right, but because a misalignment is present, the brain actually sees two separate and distinct images coming from the eyes. The brain recognizes that this is not appropriate and forces the eyes to align properly against their natural positions. This corrects the issue of seeing double, but places an immense strain and burden on the eyes and visual system, which results in symptoms.
As the burden on the visual system persists over time, the eye muscles become overfatigued and they lose their ability to hold the eyes in proper alignment. As a result, the eyes go back to their natural, misaligned positions causing double vision. Avoiding this at all costs, the brain then forces the eyes to go back into alignment, causing a cycle where the eyes constantly go in and and out of alignment. This constant back and forth furthers exacerbates symptoms, and is a key culprit for headaches, dizziness, and anxiety.
What Is The Profile of a Typical Patient With Binocular Vision Dysfunction?
BVD and Vertical Heterophoria are conditions that affects everyone equally across the population spectrum. There is no specific demographic indicator when it comes to BVD. It affects people of all ages, races, ethnicities, locations, and sexes equally. It is estimated that roughly 5 to 10% of the population suffers from this condition, and the majority of them do not even know it. The primary reason for this is that virtually no doctors outside of Dr. Debby and her colleagues treat this condition.
Dr. Debby and her colleagues have literally treated patients from all over the country and all over the world. The farthest patient to travel for care is a patient who flew from Australia to see Dr. Debby in Michigan. I personally flew from New York to see her in Michigan. While I was there, I met a woman from Philadelphia, a couple from Rochester, NY, and a woman from Montana, all of whom travelled to Michigan for care. This illustrates how far reaching this condition is. Fortunately for those who are not in the Michigan area, Dr. Debby has started working with other doctors around the country to treat this condition, though the number of doctors is still very limited.
Where Is The Closest Binocular Vision Doctor Near Me?
To see the doctor closest to you, you can check out Dr. Debby's website. It features a searchable map that shows all the current BVD doctors that work with Dr. Debby.
Binocular Vision Dysfunction Causes
Although BVD and Vertical Heterophoria can potentially affect everyone equally, there are two distinct ways in which a person ends up with the condition. The condition is either congenital (something you are born with), or acquired- usually through trauma for the latter.
Congenital
For some who are born with the condition, the symptoms of BVD are present from birth. Most of these patients are unaware that something is wrong because they simply have nothing to compare their reality to. They assume that everyone else sees and experiences the world the same way. For some, the symptoms are generally more tolerable earlier in life- when the body is still relatively flexible, adaptable, and strong- leading the patient to believe they are normal. As these patients age and their bodies go through prolonged stress however, the symptoms start becoming worse and worse. For other patients, the symptoms are very bad from the time they are born, but these patients live their symptoms, not knowing any better. How, when, and what symptoms surface varies from patient to patient.
For yet another subsection of patients who are born with BVD, the symptoms of the condition can lay dormant for many years and surface much later on in life. This can range from early adulthood to as late as the patient’s 50’s and 60’s. These patients are actually symptom free throughout this period. The body is extremely resilient and will cope with the burden of this condition for as long as it can. As the patient begins to age however, the stress overloads the system and the body begins to break down. Some patients experience a gradual onset of more and more symptoms, while others are bombarded with a variety of issues all at once.
Acquired
BVD can also be acquired- most commonly by trauma to the head or from a Traumatic Brain Injury (TBI). Any trauma to the head including accidents, falls, sports injuries, or blows to the head can bring on the onset of VH. It is important to note that even seemingly minor incidents such as a slight fall can be all it takes. The trauma either physically shifts the alignment of the eyes or causes a shift in the way the brain operates and processes what it is receiving from the eyes. A TBI can also be acquired from any internal trauma, such as a stroke or medical issue.
Of the patients Dr. Debby has treated, roughly 14% of them are from trauma and Traumatic Brain Injury patients. It is estimated that half of all current TBI patients in the general population with persistent post concussive symptoms can be helped to some degree with prism glasses.
The Exception
In addition to the two main ways in which BVD is acquired, I do personally believe there is a third way that BVD can be acquired which is much less common and which I am a part off: patients with neck injuries and neck misalignments. Please note this is based off of my personal experience and is merely my opinion. Here's my experience with BVD:
Upon being evaluated by Dr. Debby, it was determined that I had both a vertical and horizontal misalignment of my eyes and I was promptly prescribed a pair of prism glasses. The glasses helped alleviate some of my symptoms, although a lot of them persisted. Dr. Debby suspected an underlying neck condition and urged me to have my neck checked. I met a chiropractor who specialized in the upper neck, who confirmed I had a severe neck misalignment. A month after being under chiropractic care and having my neck back in proper alignment, my eyes were reevaluated. It was determined that my vertical misalignment had resolved and all I had left was the smallest amount of horizontal misalignment possible. There was a direct correlation between the misalignment of my neck and the misalignment of my eyes.
Impossible as it may seem, this actually makes sense physiologically. If you look at the anatomy of the head and neck, three of the twelve cranial nerves that innervate the eyes and control the movement of the eyes actually emerge from the brainstem from the base of the skull, and loop their way back up, and into the eyes. If there is an injury or neck misalignment interfering with the brainstem and these cranial nerves, it is conceivable as to how this may have an effect on the alignment of the eyes.
Binocular Vision Dysfunction Treatment
Diagnosis of BVD and Vertical Heterophoria is performed through a very thorough and comprehensive eye exam using equipment and techniques developed by Dr. Debby. It is an eye exam probably unlike any other a patient has had before, yet is completely non invasive. The tests are more akin to very simple visual games.
Once measurements have been taken and all the tests performed, the patient is fitted with a pair of trial glasses containing a specific amount of prism based on the patient’s data. From that point on, it is just a matter of adjusting the amount of prism until the prescription that provides the patient with the most comfort is found. The results of the glasses are almost instantaneous, with patients feeling a significant reduction in their symptoms. In most cases, patients will know within their first visit whether the prism glasses will help them or not.
After the proper prescription is found, it is simply a matter of having the glasses made. It is important to note that while most patients will have a significant reduction of symptoms with their first pair of glasses, follow up visits and adjustments to the prescription may be needed in order to maintain or improve the reduction of symptoms even more. The eyes and brain can only take so much change at once, and may be ready for more prism once it has adapted to this new, but natural way of seeing. This is known as Progressive Relaxation, where the eyes relax more and more over time.
Binocular Vision Dysfunction Test
If you think you might have BVD, there is a quick 5 minutes test you can do at home.
Binocular Vision Dysfunction and Prism Glasses
The glasses work by incorporating a prism into the lens. A prism takes any light that passes through it and bends it at a certain angle. How much the prism bends the light is dependent on the strength or prescription of the prism. The prism also controls the direction in which the light is bent. A vertical prism bends the light up or down while a horizontal prism bends the light in or out (left or right). Combining a vertical and horizontal prism bends the light diagonally.
In this sense, the prism or prisms in the lens takes the images (light) passing through it, and is able to shift (bend) them in any direction and at any angle. Shifting the images to where the eyes naturally want to be in their misaligned position allows the eyes to rest and see naturally from this position. This provides immense relief and tension on the visual system, as the misaligned eyes no longer have to work to create a single image. There is actually nothing wrong with the eyes themselves being misaligned. It is the brain’s natural intolerance to seeing double and forcing the eyes to align against their natural positions that burdens the system.
Prism Glasses Versus Other Treatments
Prism glasses for the treatment of Binocular Vision Dysfunction and Vertical Heterophoria are a completely unique treatment. There are other treatments and therapies aimed at improving symptoms from visual imbalance, but they are different in many key aspects.
Vision Therapy
One of the more common (but still extremely unknown) therapies is Vision Therapy. Vision Therapy is a form of vision rehabilitation that is designed to help patients relearn to use their eyes properly again. For a variety of reasons, the ability to use both eyes together properly becomes weaker and weaker for many people. Vision Therapy aims to retrain the patient to use both eyes properly through a variety of exercises and other methods. These exercises train patients in visual skills such as accommodation, eye teeming, focusing, and scanning. Vision therapy provides many great benefits to patients, but there are many instances where it may not provide the relief needed. At the end of the day however, Vision Therapy is still a very powerful tool. In fact, utilizing Vision Therapy after a patient has been fitted with the proper prism glasses can enhance progress exponentially.
Prism Glasses
Prism glasses have been used as a treatment option for many years, but with a completely different approach. Prism glasses have been typically used in cases where there is an obvious and large measurable deviation of eye alignment. For many patients with BVD, there will be no detectable misalignment of the eyes with conventional tests because the brain is forcing the eyes to align themselves. The tests for BVD are able to detect the underlying eye misalignment even when the eyes seem perfectly aligned.
The treatment for BVD developed by Dr. Debby is also based on the idea of progressive relaxation. This is the idea that the eyes are only able to tolerate minuscule amounts of prism initially. This is usually a result of being forced to hold the eyes in alignment for so long. While conventional prism usage usually prescribes a large amount of prism at first, the prism glasses for BVD uses tiny amounts of prism at first. In fact, many patients are only able to tolerate one diopter of prism at first, which is the smallest amount of prism possible. After the eyes are given the chance to relax and become more comfortable with a little prism, they become ready for a stronger prism. As the eyes continue to relax further and further, more and more prism is added until the correct and actual amount of prism the patient needs is reached. Patients typically change prescriptions 3-6 times before finding the final and most comfortable prescription for them. Patients typically experience the most relief from the initial pair of prism glasses, with each subsequent prescription change enhancing the improvements the patient feels.
Outlook
Prognosis for patients diagnosed with VH and prescribed prism glasses is extremely positive. Patients report an average reduction of symptoms by 80%, which is an astounding figure when compared with alternative options. As mentioned earlier, patients will know within the first visit if the prism glasses will indeed help them. There is no trial period or adjustment process to gauge the effectiveness of the glasses. Patients will experience an immediate significant reduction of symptoms with things improving more and more as the body is given time to adjust.
Many patients who are on medications for their symptoms are also able to lower the strength of their medication and eventually stop their medication altogether. Since treatment of VH addresses the underlying cause, medication aimed at treating the symptoms are no longer necessary.
Is Binocular Vision Dysfunction the Cause or Effect?
As with any condition or treatment, one of the trickiest things is to figure out whether it is the cause, or simply an effect of something else.
While BVD certainly is the main cause of issues for most people, BVD was actually a secondary issue for me personally.
The first pair of prism glasses I was prescribed didn't help me, and actually made my dizziness much worse initially. It was a kind of dizziness I had never experienced before, and I was suffering horrible symptoms for a month- even after I stopped wearing the glasses.
Subsequent prism glasses were way more tolerable and better than the first pair, but they never resolved my issues the way they did for others.
As mentioned earlier, I decided to go see a chiropractor to see if it would help me at all. The chiropractor determined I had a neck misalignment and after I got adjusted, I had another eye exam, and it was determined my eye misalignment went away. I no longer needed prisms in my glasses.
This blew me away and really made me realize that the body is an extremely complex system. Everything works in conjunction with each other, and what we think may be the issue, is not actually the issue.
Structural issues can be the cause for some people, while BVD can be the cause for others.
How To Determine What The Cause Is
Unfortunately, there is no right answer and no definitive way to determine which is the cause and which is the effect. Luckily, knowing is half the battle, and being aware of your options allows you to make a better decision. More importantly, it affords the flexibility to pivot if an option ends up not working out.
So between structural work and getting prism glasses for BVD, what should you try first? It really depends on your overall situation and how you feel inside, but here are some things to consider:
Structural Work First
From my personal opinion, it will always make sense to try structural work first because things like chiropractic care, craniosacral therapy, cranial release, and other modalities can affect the alignment of the eyes.
As a result, getting structural work done first will determine for certain if that is indeed the root cause for you. This also prevents any progress made with BVD being altered and needing to start the prism process all over again- if getting structural work as a second option does indeed end up changing your eye alignment. If structural work turns out not to be the main cause of your issues, it is still a fundamental piece of healing to have your body balanced and aligned.
The biggest drawback to this approach however, is time and money. Healing doesn't happen overnight, and for some, structural work may take some time before you notice any improvement. For others, you may need to try different techniques or doctors and practitioners before you find one that works for you.
Binocular Vision Dysfunction First
Conversely, trying BVD is a quick option because you can find out very quickly if prism glasses for BVD will help you or not. If it is indeed the cause of your problems, you will probably have a good idea during the eye exam. If not, you should know definitively by your second or third pair of glasses. If it turns out to be what will help you, great. If not, you can move on.
The biggest drawback to this approach is accessibility to the treatment. There are only a handful of doctors that treat BVD at the moment, and they are scattered throughout the country. Unless there is one that is located close to you, you will most likely need to make a long drive or fly to go see the doctor closest to you.
If you are close to one, then it may make sense to try it first. If you're not however, it becomes a much trickier prospect. As mentioned earlier, it really depends on your situation and more importantly, how you feel. It may be frustrating to not have a clear cut answer, but don't get discouraged. Having options means there is still hope.
Hopefully, this information will help you in some way, and more importantly, help you on your path to healing.
About Alan
I started Inspired Wellness to help others based on my experiences. I write about everything I've tried and learned in my search for answers to my headaches, dizziness, anxiety, digestion issues, and more for 14 years.
