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Your Guide to Binocular Vision Dysfunction (BVD) and Vertical Heterophoria (VH)

Binocular vision dysfunction (BVD) and Vertical Heterophoria (VH) are two vision issues which may surface after someone suffers a traumatic brain injury, such as a stroke. Both of these conditions can have significant impacts on one’s quality of life. Fortunately, effective treatment options are available.

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Your Guide to Binocular Vision Dysfunction (BVD) and Vertical Heterophoria (VH) Optometrist

Your Guide to Binocular Vision Dysfunction (BVD) and Vertical Heterophoria (VH) Videos

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What are Binocular Vision Dysfunction and Vertical Heterophoria?

Binocular Vision Dysfunction

Binocular vision is the ability of the eyes to work together as a team, so the term binocular vision dysfunction means that there is a misalignment between the lines of sight of each eye. This misalignment can be horizontal, vertical, or both. If the misalignment is severe enough, the patient will experience double vision or diplopia, while minor misalignments will have the patient still see a single image, but still cause eye strain, which can lead to other problems.

Vertical Heterophoria

Vertical heterophoria is a type of binocular vision dysfunction which is believed to be caused by a lack of proper coordination between the two main vertical eye alignment mechanisms; the balance (vestibular) system and the vision (oculomotor) system.

Symptoms

Vertical heterophoria can lead to a number of symptoms, some of which might not be immediately associated with vision.

These include:

Dizziness

Feelings of dizziness can come and go for someone with vertical heterophoria, and it can be triggered by a range of actions, such as”

  • standing up quickly
  • moving the head from side to side 
  • straightening up quickly after bending over
  • Rounding curves in a car
  • Driving at high speed in traffic
  • Riding in a car as a passenger

Head, Neck, and Shoulder Pain

Other signs you have vertical heterophoria include head pain (specifically at the temples, forehead, and the back of the head). The intensity of these headaches can also vary. Those suffering from vertical heterophoria may also experience a feeling of heaviness near the crown of the head, comparable to the pressure from sinus pain.

Neck and shoulder pain can result from head tilting to compensate for the vision difficulties caused by the misaligned eyes.

Anxiety

Anxiety, specifically while driving, is also a common symptom of vertical heterophoria.

Particular issues which may occur include:

  • Perception that signs and stoplights are moving or that your vehicle is moving backward even while you are pressing the break, which makes it hard to come to complete stops when required.
  • Generally anxiety regarding driving, due to concerns about experiencing dizziness while behind the wheel.
  • The perception that stationary objects at the edges of your vision are moving.
  • Uneasiness if places with high ceilings, due to sensory overload or disorientation due to a high level of visual stimuli.

Trouble Balancing

The dizziness caused by vertical heterophoria can also lead to trouble balancing, which can make everyday actions like going up the stairs dangerous.

What Causes Vertical Heterophoria?

What Causes Vertical Heterophoria?

There are two main causes of vertical heterophoria: traumatic brain injury (such as an accident or a stroke), and congenital causes.

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How is Vertical Heterophoria Diagnosed?

How is Vertical Heterophoria Diagnosed?

A diagnosis of a binocular vision dysfunction, such as vertical heterophoria, can be made following a comprehensive vision evaluation performed by a neuro-optometrist. Basic eye tests may not detect these, and some of the symptoms may not lead people to suspect a vision issue.

 

How are Binocular Vision Dysfunctions Such as Vertical Heterophoria Treated?

  • Prism Lenses

Prism lenses can provide relief from symptoms such as double vision, as they help you compensate for the misalignment. However, these more provide short term relief than proper treatment.

  • Vision Therapy

Vision therapy, on the other hand, helps you (re)develop the visual skills necessary to maintain proper eye alignment, and once this ability is gained, the problem, in most cases, is completely resolved. 

Surgery is in most cases not recommended for these conditions. 

Symptoms
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Common Questions

Vertical Heterophoria (VH) is a type of binocular vision dysfunction wherein the eyes are misaligned vertically. Various triggers can cause or exacerbate VH. Traumatic brain injuries, congenital factors, or other acquired incidents involving the head or eyes can lead to its onset. It's often associated with a subtle misalignment that might have been present since birth but becomes symptomatic later due to certain triggers.
The most common causes include congenital factors, trauma to the head or eyes, or conditions like strabismus or amblyopia. Sometimes, a person can go years without noticeable symptoms, but an incident or increased visual demand can bring them to the forefront.
Diagnosing binocular vision dysfunction involves a comprehensive eye examination by an eye specialist, focusing on how the eyes function together. It includes detailed testing of eye movements, alignment, and coordination. Prisms might be used to measure and correct the misalignment. A neuro optometrist, trained in neuro optometry, would be adept at diagnosing and treating BVD and providing specialized care tailored to the patient's unique needs.
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Summary

Binocular vision dysfunctions such as vertical heterophoria can have extremely negative impacts on your quality of life, with the symptoms of dizziness, anxiety, and others making day-to-day tasks difficult or even dangerous. However, vision therapy by certified neuro-optometrists can effectively treat the condition. If you suspect you might be suffering from a binocular vision dysfunction, you can reach out to your nearest Amplify EyeCare practice either via a call or in-person visit to schedule a comprehensive vision exam. Our team of eye care professionals is ready and equipped to provide you with the care you need.

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