“Why didn’t my last doctor check for binocular vision dysfunction?”
Unfortunately, about 90% of the time, they don’t. Most ophthalmologists are not trained in binocular vision dysfunction and are more concerned about the health of the eye itself (i.e., Retina and optic nerve). The eye’s health is important and allows us to know why there may be reduced visual acuity, but it does not tell us how the eyes work together, just how each eye sees.
“If I have 20/20 vision, then why do I still have headaches, dizziness, and anxiety?”
20/20 vision only tells us the sharpness and clarity of vision in each eye; it does not give us any information on the binocular status of your eyes. Binocular Vision Dysfunction (BVD) includes convergence insufficiency, convergence excess, divergence insufficiency, divergence excess, vertical heterophoria, superior oblique palsy, and vertical heterophoria. These BVD diagnoses are some of the most common.
“How is BVD tested?”
We test for BVD through a sensorimotor exam. Von Graefe testing is not an accurate way of measuring binocular vision as it does not tell us how the eyes are aligned in free space at distance and near or in different positions of gaze. A sensorimotor exam tests for diplopia, horizontal, and vertical phorias.
“I’ve had binocular testing done by an eye doctor, and everything was fine. Why would your testing be any different?”
Our evaluation is different than any other doctor, unless Dr. Debby Feinberg trained them. Dr. Feinberg developed NeuroVisual Medicine and the protocol for measuring and treating binocular misalignments, specifically Vertical Heterophoria. Vertical Heterophoria is when the retinal images are slightly misaligned on the vertical plane. Headaches and dizziness are the most common symptoms of this binocular vision dysfunction. Through the Feinberg Method, we can measure and treat binocular misalignments to the quarter of a prism diopter. Most doctors do not have the knowledge or “toolbox” to be able to do this.
“I have tried prism and it did not work. How is your prism different?”
Through our training by Dr. Debby Feinberg, we can measure and prescribe prism to the quarter of a prism diopter. Less is usually always more. Although people can have large horizontal and vertical misalignments, it is false to think that they need a large amount of prism to correct them. During our prism evaluation, we can trial frame the aligning prescription and use the least amount of prism to alleviate symptoms.
“I’ve done vision therapy for convergence insufficiency, but never got any better. Why would NeuroVisual Medicine help me?”
In most of these cases, the patient has an undiagnosed vertical phoria. It is impossible to train convergence when you have one eye seeing an image slightly higher than the other. Therapy cannot train one eye to come down or one eye to come up independent of the other eye. The anatomy of our eye muscles does not work that way. After correcting the vertical heterophoria with microprisms, the convergence often gets better, too, since both eyes can then work together on the same horizontal plane.
“Can a cover test diagnose BVD, specifically vertical heterophoria?”
A cover test will not be able to detect a small vertical phoria. The naked eye is unable to see 0.25 to 1.00 prism diopter vertical phoria. Most offices also only have the means of then measuring these phorias in diopter steps of prism (i.e., 1, 2, 3, etc.). At our office, we are able to measure to the 0.25 of a prism diopter, and we do not rely on a cover test to measure our vertical phorias. We use specialized equipment that allows us to measure these minute deviations.
“How do I know that my symptoms of dizziness, headaches, and anxiety are coming from my eyes?”
There is a quick test called the 5-minute cover test, which will answer that question. If your symptoms improve by covering one eye, then you are most likely suffering from a binocular vision dysfunction. If this is the case, please call our office to make an appointment for a Neurovisual Evaluation at 516-224-4888.
I suspect I may have BVD as I noticed issues when driving and tried many things.
I’m in UK and wondering if I could travel over to visit, is this possible? Or do you have any UK partners?
Kind regards
Martin
Hi Martin
We do have many patients who travel to us from Europe. You can contact us at info@nvcofny.com.
All the best
The Neuro Visual Center
I’m a veteran in Virginia. Does the va clinics do these tests or do you have a clinic in Virginia
Is there anyone or a group in the U.S.A, that has this practice? Where are the located.
We are located in New York.
Dear doctor,
I am 22 year old student from india and i think i have been suffering from bvd since the past 4 years. I am miserable and depressed as all the doctors that i consulted told me that my eyes are normal and there is nothing wrong with it.
I came across your website on google and tried the 5 minute cover test. All of my symptoms just dissapears when i do so. I have even been feeling suicidal in the past because it’s becoming so hard for me to continue with this torture.
I think that i might have no other option but to try saving up from now and plan a trip to new york so that i could get treated by you.
If i were to do so, how many days will i need to be be staying in new york from the time i get an appointment and get my prism glasses? How much will the appointment and the prism glasses cost?
Please, please help me doctor
Dhruba
We have sent you an email.
Hey dhruba I am from India and I also have the same problem and everyone says l am normal please let me know what have you done to correct your problem and depressed so much please tell
I live in Upstate NY is there a partner in my area that we may connect with for this test? I am north of Syracuse and have been trying to find a solution for over a year. MRI is fine – ENT say it is not vestibular vertigo -and we have made sure my blood work is good. Walmart and the mall make me so off balance as of walking on a passenger train.
Please visit the Vision Specialist of Michigan website to find all the trained doctors.
All the best,
The Neuro Visual Center
Please call the office if you would like to schedule an evaluation.
516-224-4888
Yes we do
Hi. Can a person develop bvd from having an attack of optic neuritis? If yes, at what point in recovery can you be seen and start treatment. Thank you.
If a person had BVD that their body was compensating for they may decompensate after optic neuritis. However, the optic neuritis would not cause the BVD.
Interesting. I was treated for convergence insufficiency for about six months & was doing well before optic neuritis started 10 weeks ago. Maybe my temple throbbing & lightheadedness are signs of decompensation. Maybe I should pull out my brock beads.
Hi there do you have someone you recommend in Florida that specializes the same.
Yes, Dr. Erin Sonneberg in Boyton Beach.
Hello, is there a doctor you can recommend at John’s Hopkins who specializes in this condition?
I am sorry, not that I know of.
All the best,
The Neuro Visual Center
Is it possible for the brain to decompensate over night? I’m pretty sure I’ve had BVD my entire life. I was diagnosed with a lazy eye as a child and often have to read with one eye closed. I’m told I also often tilt my head, and my vision is worse in one eye. However, I’ve never had any headaches or dizziness from it. However, seemingly over night, I started experiencing daily debilitating headaches and nausea that are uncontrolled by medication. I feel pressure throughout my head and a general sense of malaise. My head CT and MRI are normal, apart from an obvious misalignment of my eyes which is evident on the MRI. I’ve seen two ENTS,a neurologist and opthamologist, who noted the misalignment of my eyes on the MRI but didn’t think it had anything to do with the headaches. It’s been six months now and the daily light sensitivity, headaches and dizziness is debilitating. I work in a visual field and I’ve been forced to drastically cut back at work. I’ve tried a number of different migraine medications and none have made any difference to my symptoms. I’m at a loss. I seem to have all the symtoms of BVD, but I’m having trouble understanding how they could develop overnight seeing as I’ve had a lazy eye my entire life with no such symtoms. Is it possible for the body to suddenly decompensate?
Thank you.
Yes it is possible to decompensate very quickly especially under times of stress or when you get to a certain age.
All the best,
The Neuro Visual Center
I am an 81 yr old female widow. In the past 4 months I have had episodes where my eyes are out of alignment all of a sudden. If I cover either eye I can see fine. If I just try to see normal everything is about 1/4 to 1/2 inches off from being even. It will go away in a few minutes then I am fine. Is this BVD or something else? I have had cataract surgery on both eyes some time ago. Other than that I have no eye problems other than wearing reading glasses
Yes this is a form of Binocular Vision Dysfunction.
Hi, I had Covid for the 2nd time and recovered very quickly with fairly mild symptoms, loss of smell/taste temperature etc. approximately 2 weeks after testing negative I had pain in the back of my eyes and within days developed double vision which comes and goes, which goes if one eye is covered. CT head was normal and a visit to the Optition showed some misalignment and I was prescribed glasses with a prism. With the glasses there is some improvement , but it is very difficult to function like this. I f I continue with the glasses should the improvement continue as I feel very miserable indeed. Could this have occurred as a result of Covid and might it just disappear as quickly as it started?
Hi Blanche,
Every case is different. We can not comment on your individual case. Please visit your doctor. However, we have seen multiple cases of double vision after COVID.
Best of luck
The Neuro Visual Center
This is very enlightening. I have almost quit driving due to dizzy spells and feeling like I might pass out – but it only happens when driving for extended periods of non-stop (highway). Doctors want MRIs, ENTs, etc. But I have no other symptoms. Could this be BVD?
Yes it can be BVD.
Do you know anyone in the Boston area that specializes in diagnosing and treating BVD? Or vision therapy for BVD/ eye misalignments? Thanks in advance.
I am sorry we do not. We see many patients from the Boston area.
The Neuro Visual Center