If you’ve been living with Ehlers-Danlos Syndrome (EDS), the group of heritable connective tissue disorders that affect collagen throughout the body, you already know how relentless the symptom list can be. Hypermobile joints that dislocate without warning. Fatigue that no amount of rest seems to touch. Chronic headaches, dizziness, difficulty concentrating, and a pervasive sense that your body is simply not holding itself together the way it should.
You’ve probably seen rheumatologists, neurologists, cardiologists, and pain specialists. You’ve had every test imaginable. And yet some of your symptoms, the persistent dizziness when you move your head, the nausea in crowded spaces, the crushing headaches behind your eyes, the strange anxiety when you’re in a busy grocery store, remain unexplained.
We see patients in this situation regularly at The Neuro Visual Center of New York. And one of the first things we ask is whether anyone has ever evaluated their eyes – not just for sharpness of vision, but for how well the two eyes actually work together. For many people with EDS, the answer is no. And that gap may be costing them enormously.
What Is Binocular Vision Dysfunction?
Binocular Vision Dysfunction (BVD) is a condition in which the two eyes are subtly misaligned – not necessarily in a way that’s visible to others or that shows up on a standard eye exam, but enough that the brain is forced to work overtime to compensate. That constant effort to fuse two slightly different images into one coherent picture is exhausting, and it produces a range of symptoms that often have nothing to do with how clearly you can read the eye chart.
The symptoms of BVD can include chronic headaches and migraines, dizziness and balance problems, anxiety in open or crowded spaces, motion sickness, nausea, neck and shoulder tension, brain fog, and difficulty reading or maintaining focus, even when prescription lenses seem to be correct. Because these symptoms overlap so completely with other conditions, BVD is routinely misdiagnosed as migraine disorder, anxiety, vertigo, ADHD, or sinus problems. Patients go years, sometimes decades, without ever learning that their eyes are involved.
For people with EDS, this diagnostic delay is even more common, because so many of those symptoms are already attributed to the underlying connective tissue disorder.
Why EDS and BVD So Frequently Overlap
Here is the connection that most healthcare providers (even experienced EDS specialists) don’t fully appreciate: collagen is absolutely foundational to the structure of the eye.
In fact, roughly 80% of ocular structures are composed of collagen. The sclera (the white of the eye), the cornea, the vitreous humor, the tendons that attach to and move the extraocular muscles – all of it depends on healthy, well-organized collagen to maintain its integrity. When EDS disrupts collagen formation and function throughout the body, the eyes are not exempt.
What this means in practical terms is that the connective tissue laxity characteristic of EDS can affect the muscles and tendons that control eye movement. When those structures are looser or less stable than they should be, the eyes may struggle to maintain precise alignment, especially during movement, reading, or when fatigued. The brain perceives this misalignment as a threat to stable vision and works continuously to correct it. That compensation effort is what drives the headaches, the dizziness, the light sensitivity, and the cognitive fatigue that so many EDS patients describe.
Peer-reviewed research has begun to document what many of our patients already know from experience. A 2023 observational study published in Applied Sciences found that among EDS patients evaluated for ocular motility, a significant percentage showed eye muscle deficits, including in the medial and lateral rectus muscles, with statistically significant associations between those deficits and both diplopia (double vision) and eye pain. Another large-scale analysis published in the journal Eye found that patients diagnosed with EDS showed elevated rates of concurrent ocular pathologies compared to the general population, and the authors recommended ophthalmological evaluation as part of the initial care workup for newly diagnosed EDS patients.
This is a population that deserves to have their eyes looked at, carefully, and by someone who understands what to look for.
The Symptoms That Get Missed
One of the reasons BVD goes undetected in EDS patients is that the symptoms it produces are so easy to attribute elsewhere. Consider how often the following complaints appear in an EDS patient’s chart:
- Chronic daily headaches, often described as pressure behind the eyes or at the base of the skull
- Dizziness or a sense of unsteadiness, especially when walking through stores or watching motion on screens
- Difficulty reading for extended periods – words seem to move, blur, or swim on the page
- Sensitivity to light and visual “busyness” (busy patterns, fluorescent lights, high-contrast environments)
- Brain fog and difficulty concentrating
- Anxiety, particularly in visually complex environments
- Neck pain and stiffness (often the result of subconscious head tilting to compensate for misalignment)
- Nausea without a clear GI cause
Each of those symptoms has an obvious home in an EDS patient’s file. Headaches? Craniocervical instability. Dizziness? POTS or dysautonomia. Anxiety? Chronic illness. Fatigue? It’s EDS. The visual connection never gets made, and the patient keeps searching.
How NeuroVisual Optometry Approaches This Differently
Standard eye exams are designed to measure visual acuity – how sharp your vision is at distance and near. They are not designed to detect the kind of subtle binocular misalignment that drives BVD. This is why BVD remains so dramatically underdiagnosed: it requires a different type of evaluation entirely.
At The Neuro Visual Center of New York, our approach centers on identifying those precise, often tiny degrees of misalignment and determining whether they are causing the patient’s symptoms. Dr. Cheryl Berger Israeloff, our founding optometrist, was the first in New York State to be trained by Dr. Debby Feinberg of Vision Specialists of Michigan, the pioneer of NeuroVisual Optometry and one of the foremost experts on BVD in the world. That lineage matters – it means our diagnostic and treatment approach reflects decades of specialized, evolving clinical expertise that most eye care practices simply don’t have access to.
Dr. Marissa Zimmerman, trained directly by Dr. Israeloff since 2016, brings that same depth of expertise to our patients, including to many complex cases involving co-existing conditions. Together, we’ve built a practice that is the only full-time NeuroVisual optometry practice in New York State, serving patients from Garden City, throughout Long Island, Nassau County, and across the greater New York metro area.
When we evaluate a patient with EDS, we’re thinking about the whole picture – the connective tissue laxity that may be affecting their extraocular muscles, the chronic symptom load they’re already managing, and how much relief targeted treatment might realistically offer. For many, the answer is: a great deal.
Treatment: Precisely Prescribed Prism Lenses
When BVD or Vertical Heterophoria is confirmed, treatment doesn’t require surgery or vision therapy in isolation. The cornerstone of NeuroVisual treatment is the use of micro-prism lenses – lenses that subtly redirect light entering each eye so that the brain receives properly aligned input without having to compensate for it.
At The Neuro Visual Center of New York, we have access to TheraLens®, a specialized prism lens technology developed specifically for patients with Binocular Vision Dysfunction. The prescription is highly individualized and refined through a carefully structured evaluation process. For many patients, the relief begins quickly – headaches diminish, dizziness decreases, and the mental exhaustion of constant visual compensation starts to lift.
For EDS patients, this can feel like finding a missing piece of a very complicated puzzle. The prism lenses don’t treat EDS. But by removing the burden of compensating for visual misalignment, they can meaningfully reduce the symptom burden and give patients more bandwidth to manage everything else.
A Note for the EDS Community
If you’ve found your way to this page through an EDS support group or forum, you already know how hard the diagnostic journey can be. EDS is underdiagnosed, frequently misunderstood, and often treated in fragments, one symptom at a time, by one specialist at a time, rather than as the multi-system condition it truly is.
Binocular Vision Dysfunction is one of the most consistently overlooked components of EDS care. It doesn’t show up on standard bloodwork or imaging. It rarely gets mentioned at rheumatology appointments. And yet for a meaningful number of people with EDS, it is generating real, daily suffering.
We’re not suggesting that BVD is the cause of all EDS symptoms. What we are saying is that if you’ve done the work (the physical therapy, the pacing, the medications, the lifestyle adjustments) and you’re still struggling with headaches, dizziness, light sensitivity, or cognitive fog, it may be worth asking whether your visual system has been thoroughly evaluated.
We offer that evaluation here, at The Neuro Visual Center of New York. And we’d be glad to talk with you about what we find.
Take the Next Step
If you have EDS and recognize yourself in the symptoms described above, we’d encourage you to start by completing our BVD Questionnaire. It takes just a few minutes and can give you a meaningful sense of whether BVD may be contributing to your experience. You’re also welcome to call our office directly at (516) 224-4888. At The Neuro Visual Center of New York, we’ve built our entire practice around finding and treating the visual conditions that other providers miss and we take particular pride in helping patients with complex, overlapping conditions finally get some answers.
