Binocular Vision Dysfunction (BVD) is a commonly known vision-related condition that has various underlying causes, but often presents itself with similar symptoms. Our doctors treat BVD in patients who have suffered a concussion, Traumatic-Brain Injury (TBI) or Acquired-Brain Injury (ABI). Conversely, many of our patients are diagnosed with BVD caused by decompensated visual skills. This decompensation is due to stress, increased near visual demands from work and excessive use of technology, and aging. In general, the BVD diagnosis implies that a patient’s two eyes (aka binocular vision) cannot efficiently work together as a team, thus causing a dysfunction. However, there are several different types of BVD which include:
Vertical Heterophoria (eye misalignment characterized by a vertical deviation)
Convergence Insufficiency (reduced ability to align the eyes during near work)
Superior Oblique Palsy (reduced nerve function contributing to eye misalignment)
Divergence Insufficiency (difficulty with eye alignment more prominent at distance)
Convergence Excess (excessive eye deviation during near work)
Vergence Dysfunction (overall reduced function of eye teaming at all distances)
A patient with BVD will have trouble with the eyes working together as a coordinated team caused by the line of sight from one eye to be out of alignment with the other eye. When the two eyes don’t align properly, a common way to compensate for the misalignment is to tilt, turn, or tip your head. This new improper posture of the head now negatively impacts the vestibular system. This aggravated vestibular system will cause symptoms that interfere with activities of daily living.
Another way visual system compensates for eye misalignment is by continually attempting to realign both eyes which, in turn, can further aggravate the vestibular system. These repeating cycles of misalignment and realignment cause headaches and eye pain, dizziness, lightheadedness, nausea, motion sickness and anxiety.
Also, many people are born with facial asymmetry (where one eye is physically higher than the other eye) or with an eye muscle or nerve abnormality. They develop BVD over time as their eye muscles become overwhelmed. While this can occur at any age, many people experience worsening of their symptoms around age 40, which is when the focusing portion of the visual system begins to decline.
Patients experience symptoms of BVD in varying degrees, from being minimally affected to feeling completely disabled.
Headache or head pain/pressure
Face ache / “sinus” pain
Eye pain or pain with eye movements
Neck ache, upper back and shoulder pain due to a head tilt
Off balanced/unsteadiness with walking/slower gait
Lack of coordination
Drifting to one side while walking – bumping into the person next to them; walks into door frames and furniture, often with the same side of the body
Difficulty walking down grocery aisle
Feeling overwhelmed or anxious in crowds
Feeling overwhelmed or anxious in large, contained spaces with tall ceilings like malls or big box stores
Anxiety from driving, especially on the freeway
Suicidal ideation from anxiety
Fitful and restless sleep
Difficulty sleeping unless room completely dark
Difficulty with concentration, re-reading for comprehension
Fatigue with reading
Difficulty with reading
Skipping lines while reading
Using a line guide (finger, ruler, envelope) to maintain one’s place while reading
Words running together while reading
Losing one’s place while reading
Blurred vision at near or far distances
Difficulty with close up vision (i.e. – reading or computer use)
Difficulty with night vision
Double or overlapping vision
Difficulty with glare or reflection
Closing / covering one eye eases visual tasks
Poor depth perception / difficulty with eye-hand coordination (e.g.- difficulty catching or hitting balls)
Trouble stopping in time due to difficulty estimating distances
Driving causing anxiety, especially on the freeway, bridges or driving alongside semi-trucks
Difficulty maintaining eye contact when in conversations
With the wide array of symptoms, it is not unusual for patients to have sought help from a number of different types of doctors, usually without adequate relief. Most people would not have thought that the visual system could be the cause of these symptoms, and as a result have not sought help from a vision specialist.
Not uncommonly, people who suffer from BVD have been diagnosed with other conditions (like migraines, reading and learning disabilities, ADD/ADHD, anxiety/ panic disorders, sinus problems, TMJ disorders, agoraphobia, Meniere’s Disease, MS, stroke, cervical misalignment) when the cause was BVD.
Patients must undergo a Neuro-Optometric Evaluation, which is a detailed and thorough examination of visual function. The assessment includes evaluating for even small amounts of eye misalignment that are causing the symptoms of BVD (and that are not routinely identified on standard eye examinations). Problems with near vision, far vision and alignment can be corrected using glasses with special aligning lenses, resulting in a reduction (or sometimes elimination) of symptoms. Some of our patients may also benefit from at-home vision exercises and in-office vision therapy.
Clarendon Vision Development Center doctors are experts in this area and have completed extensive training through the NeuroVisual Medicine Institute founded by Dr. Debbie Feinberg of Vision Specialists of Michigan.
Watch this video that shares stories on how patients have experienced and overcome BVD.
“Went to Clarendon for a second opinion for BVD (Ophthalmologist said I didn’t have it). I was getting dizzy driving on the highway and my symptoms matched what I was seeing online for BVD. Clarendon had the tools to test for BVD and diagnosed me with BVD and fitted me with glasses that fixed my issue.”
“Clarendon Vision was able to help me with a convergence insufficiency that other optometrists missed for Decades.”