You Mean It’s My Eyes? Understanding Binocular Vision Dysfunction

Common Symptoms of Binocular Vision Dysfunction

Binocular Vision Dysfunction can cause a wide range of symptoms, varying in severity from person to person. Commonly recognized visual symptoms include blurry vision, eye pain, light sensitivity, double vision, overlapping vision, and poor depth perception. However, many other binocular vision symptoms may also occur, sometimes leading to significant life disruption or disability.

Pain Symptoms

• Eye Strain (asthenopia) and Fatigue: Experiencing tired or sore eyes, especially after prolonged visual tasks such as reading or using a computer.
• Eye Pain: Most people with BVD will experience eye pain from the slight misalignment of their eyes.

• • Migraine Disorder: Frequent and severe headaches often accompanied by other sensory disturbances.

• Aching Face/“Sinus” Pain: Some people experience aching and pressure in their sinus area and mistake it for a sinus infection. 

Visual Symptoms

• Blurred Vision: Perhaps the most common BVD symptom. Blurry vision occurs when the eyes struggle to work together to produce a clear image.

• Double Vision (diplopia): This common symptom occurs when the eyes strain to produce a single picture. With double vision, there appear to be two of everything or your vision has shadowed layers overlapping each other.

• Light Sensitivity (photophobia): Individuals with BVD often experience discomfort or pain when exposed to bright lights or sunlight. This can result in squinting, eyewatering, or even headaches, as the eyes strain to adjust to varying light conditions.

• Difficulty with Glare or Reflection: Glare from surfaces like screens, water, or car windows can be particularly challenging for those with BVD. The inability to properly filter or process reflected light may lead to visual fatigue and discomfort.

• Poor Depth Perception: People with BVD may struggle to accurately judge distances, making tasks like driving and playing sports difficult. 

• Difficulty Maintaining Eye Contact: Many people with BVD avoid or struggle to maintain eye contact with others, as doing so can cause pain or discomfort.
• Head Tilt or Turn: A tendency to tilt or turn the head to one side to alleviate visual discomfort or to try to improve visual clarity.

• Difficulty with Night Vision: People often experience heightened difficulty seeing clearly in low-light conditions or at night. 

Nonvisual Sensory Symptoms

• Dizziness/Lightheadedness: Some experience dizziness or lightheadedness, due to the brain’s struggle to process conflicting visual information from misaligned eyes. 

• Nausea: Visual strain and misalignment caused by BVD can trigger nausea, especially during activities that require focus, such as reading, driving, or watching screens.

• Frequent Falling: People may experience balance and coordination issues, leading to frequent falls. This can be due to issues with depth perception and spatial awareness, both of which are impacted by the eyes’ inability to work together.

• Disorientation: BVD can cause feelings of disorientation or confusion as the brain tries to make sense of conflicting visual input.

• Motion Sickness: Many people with BVD experience motion sickness in moving vehicles. The brain’s difficulty in processing visual and vestibular (balance) input simultaneously can make activities like riding in cars, uncomfortable or nauseating.

• Visual Vertigo: A sensation of dizziness or spinning triggered by certain visual stimuli.

Reading Symptoms

• Difficulty with Reading: Struggling to read for extended periods due to visual strain, words appearing to move on the page, or needing to reread lines, leading to difficulty with comprehension. Having difficulty focusing is also a common sign.
• Fatigue with Reading: Reading can be especially exhausting for those with BVD, as the extra effort required to maintain focus can quickly lead to visual and mental fatigue. 
• Rereading for Comprehension: People with BVD may frequently need to reread passages to understand them fully, as their eyes struggle to align and track text accurately.
• Skipping Lines: BVD can make it difficult for the eyes to move smoothly across lines of text, leading to unintentional skipping of lines or paragraphs.
• Words Running Together: Those with BVD may experience a blurring or merging of words on the page, making it hard to distinguish individual words.

Psychological Symptoms

• Restless Sleep Pattern: Difficulty sleeping or experiencing an irregular sleep pattern due to discomfort caused by BVD.
• Generalized Anxiety: Individuals with BVD may experience ongoing anxiety stemming from the daily struggle to interpret visual information accurately. 

• Overwhelm in Crowds: Visual stimuli in crowded or busy environments can feel overwhelming for people with BVD, as their brains work harder to process complex visual input. This overstimulation can lead to feelings of stress, irritability, and even physical discomfort.

• Agoraphobia: Some individuals with BVD may develop a fear of leaving familiar or controlled environments, as they feel more vulnerable in open spaces or places where visual disorientation and imbalance are intensified. This can lead to avoidance behaviors and a reluctance to engage in daily activities outside the home.

• Panic Attacks: BVD-related visual stress can trigger panic attacks, especially in situations that are visually or physically disorienting. Symptoms may include rapid heartbeat, sweating, shortness of breath, and a sudden feeling of fear or impending danger, often without a clear cause.
• Suicidal Thoughts: In severe cases, the chronic strain, discomfort, and psychological distress associated with BVD can contribute to feelings of hopelessness and suicidal thoughts.

Living with BVD

Living with Binocular Vision Dysfunction (BVD) impacts everyday experiences in ways many people may not expect. Common symptoms like dizziness, headaches, and double vision can make routine activities challenging. 

For instance, reading can become tiring due to frequent loss of place on the page or words appearing to blur or shift. Driving, especially in traffic, can feel overwhelming because of difficulty focusing and judging distances accurately. Even walking or being away from home may feel disorienting,  particularly if it involves busy or visually complex environments like malls or grocery stores, crowds, or wide open spaces.

People with BVD often experience persistent eye strain, fatigue, or tension, especially after tasks requiring focused vision, like working on a computer or looking at digital screens. Simple actions, such as descending stairs or moving through crowded spaces, can feel surprisingly difficult. 

Daily life with BVD can be frustrating, especially since these symptoms can easily be mistaken for unrelated health issues, leading to delays in effective treatment. However, once diagnosed, tailored treatments like microprism lenses can significantly improve these symptoms, making daily life more comfortable and reducing the stress associated with BVD.

Risk Factors

Risk factors for BVD include:

1. Genetics: Family history of BVD or other eye alignment issues can increase susceptibility.
2. Head Trauma: Concussions or head injuries can disrupt eye alignment, leading to BVD.
3. Chronic Eye Strain: Prolonged use of digital screens or frequent near-focus activities can strain eye muscles, can potentially exacerbate underlying misalignment.
4. Existing Vision Conditions: Those with a history of strabismus (crossed eyes) or amblyopia (lazy eye) may be more prone to developing BVD.
5. Age: Changes in eye muscle function or coordination with aging can contribute to BVD.
6. Infectious diseases: COVID-19, Lyme disease, and Mononucleosis (Mono) are examples of diseases that can lead to brain inflammation or acquired brain injury, increasing the risk of developing BVD.

Identifying and addressing these factors early can help manage or reduce the severity of BVD symptoms.

Diagnosing BVD

The Role of a NeuroVisual Evaluation

To effectively determine the right prescription for microprism glasses, it is crucial to undergo a NeuroVisual Evaluation. This specialized examination is performed by NeuroVisual Medicine specialists with expertise in diagnosing and treating BVD. During the exam, the NeuroVisual Medicine specialist will assess the extent of misalignment in your eyes and precisely identify the amount of microprism correction needed to reduce symptoms.

Management and Treatment Options

Glasses with Microprism Lenses: A Solution for Binocular Vision Dysfunction

Binocular Vision Dysfunction (BVD) can cause a multitude of distressing symptoms, impacting one’s quality of life. Fortunately, there are effective solutions to alleviate these symptoms, one of which is the use of microprism glasses. Microprism glasses are more efficient and frequently more effective than vision therapy in most cases.

Understanding Microprism Lenses

Glasses with microprism lenses are specially designed eyeglasses that incorporate small amounts of prism. These lenses have the unique ability to bend light as it enters the eye, which can help address the misalignment of images in individuals with BVD.

How Prism Glasses Work

Once the results of the NeuroVisual Evaluation are obtained, the NeuroVisual specialist can prescribe microprism glasses tailored to your specific needs. These glasses work by manipulating the way light enters your eyes, effectively correcting the misalignment. By realigning the images received by each eye, microprism glasses enable your brain to easily fuse them into one clear, focused image.

Benefits of Microprism Lenses

Microprism glasses offer several advantages for individuals with BVD, including:

1. Relief from Symptoms of BVD: Microprism glasses can significantly reduce or even completely eliminate symptoms such as headaches, dizziness, double or overlapping vision, and eye strain.
2. Improved Comfort: By aligning the images correctly, microprism glasses reduce the constant cycle of misalignment and realignment in your eyes, preventing eye muscle strain and discomfort.
3. Enhanced Daily Functioning: With the help of microprism glasses, many individuals find that they can go about their daily activities more comfortably and with improved clarity of vision.
4. Neck and Shoulder Pain Reduction: Tilted head postures, often adopted by those with BVD to compensate for misalignment, can lead to neck and shoulder pain. Microprism glasses can alleviate this strain, promoting better neck posture.

Botox®: Not an Effective Treatment for BVD

OnabotulinumtoxinA (Botox®) is well-known for its cosmetic applications, but it also has medical uses, such as treating chronic migraines. While some may wonder if Botox® could help with Binocular Vision Dysfunction (BVD) due to its effectiveness in reducing muscular strain, it is not a common or recommended treatment for BVD symptoms. 

Using Botox® for BVD would not address the underlying cause of the condition. Instead, Botox® temporarily relaxes muscles, which might help relieve some tension but would not realign the eyes or improve visual coordination.

Common Misdiagnoses

Standard eye tests cannot diagnose Binocular Vision Dysfunction because they aren’t sensitive enough to detect minor misalignment causing symptoms. Since the eyes may seem to function normally, doctors often overlook vision problems as the cause unless a significant misalignment is found.

It’s common for people to have been diagnosed with a myriad of other conditions, and then find out that Binocular Vision Dysfunction was the true culprit. These other conditions include:

• ADD / ADHD
• Agoraphobia
• Anxiety / Panic disorders
• Persistent Post-Concussive symptoms
• Cervical misalignment
• Meniere’s Disease
• BPPV (Benign Paroxysmal Positional Vertigo)
• Psychogenic dizziness / Chronic Subjective Dizziness
• PPPD (Persistent Postural-Perceptual Dizziness)
• Vestibular Migraine / Migraine Associated Vertigo (MAV)
• Migraines
• MS (Multiple Sclerosis)
• Reading & learning disabilities
• Dyslexia
• Sinus problems
• Stroke
• TMJ disorders
• Traumatic brain injury (TBI)

How To Distinguish BVD From Other Conditions

Determining if you have BVD can be difficult, and it often starts by ruling out other serious conditions. If symptoms persist and the cause remains unclear, consider asking yourself the following:

• Have specialists been unable to diagnose or treat your symptoms, such as pain, dizziness, or light sensitivity?
• Have you been diagnosed with conditions that may mimic BVD?
• Did you suffer a concussion or brain injury, and your symptoms persist?

If you suspect BVD, consult your eye doctor, as the condition can worsen. Be prepared with a full list of symptoms, their duration, and why you think BVD may be the cause.

Additionally, you may wish to take the BVDQ™ Assessment, which can identify those who may have BVD and who would benefit from a NeuroVisual Medicine appointment.

Additional Resources

Frequently Asked Questions

What does BVD mean? 

BVD stands for Binocular Vision Dysfunction, a condition where the eyes struggle to work together properly, causing misalignment and visual discomfort.

How do you tell if you have BVD?

Symptoms of Binocular Vision Dysfunction (BVD) include frequent headaches, dizziness, double vision, eye strain, and difficulty reading. The BVDQ assessment can screen for those who most likely have BVD, and a NeuroVisual Medicine specialist can confirm BVD through a comprehensive and specialized visual exam.

How do you fix BVD eyes?

BVD is typically managed with specialized microprism glasses that correct the misalignment, reducing symptoms and improving eye coordination.

Is BVD a neurological disorder?

While some of the causes of BVD may be neurological in origin, BVD is not classified as a neurological disorder. BVD may cause symptoms that affect balance and coordination due to the visual misalignment affecting the brain’s perception of spatial positioning.

What are the signs of Binocular Vision Dysfunction?

Signs of BVD include headaches, dizziness, double vision, eye strain, blurred vision, and trouble with reading or focusing, especially after prolonged visual tasks.

Can Binocular Vision Dysfunction be corrected? 

Yes, BVD can often be corrected or managed with microprism glasses to improve eye alignment and coordination.

What is the hallmark symptom of Binocular Vision Dysfunction? 

A defining feature of BVD is that many symptoms aren’t immediately recognized as visual by patients. While double vision isn’t a hallmark symptom, common indicators include headaches, dizziness, and anxiety.

What do people with binocular vision see? 

People with normal binocular vision see a single, clear image as both eyes work together seamlessly. Those with BVD may see double or misaligned images due to poor eye coordination.

What exercises improve binocular vision?

Exercises like focusing on things near and then far away, using a dot card, or doing convergence training can help improve binocular vision by strengthening eye coordination and alignment.

What is the most common cause of double vision? 

The most common cause of double vision is eye misalignment, often from conditions like BVD, strabismus, or issues with eye muscles or nerves.

Let’s Treat Your Binocular Vision Dysfunction

Are you familiar with some of these symptoms? If so, we provide a free online BVDQ™ Assessment to help you learn more about your symptoms and determine whether you should seek an appointment for a NeuroVisual Evaluation. At NeuroVisual Medicine, your detailed and thorough evaluation goes above and beyond a regular eye exam, and is specifically designed to detect Binocular Vision Dysfunction. After the exam, any problems with alignment, far vision or near vision will be treated by a NeuroVisual Medicine specialist and corrected using specialized microprism glasses.