Adult Binocular Vision Dysfunction: Understanding BVD

Overview

Adult binocular vision dysfunction (BVD) is a condition in which the eyes struggle to align and work together as a team. Though often subtle, this slightly misaligned condition can cause life-disrupting symptoms such as headaches, dizziness, anxiety, and difficulty focusing and concentrating. Many adults live with binocular vision problems for years, misattributing their discomfort to unrelated conditions or aging.

Unlike typical vision problems corrected by standard glasses or contacts, BVD stems from the way the brain and eyes coordinate. It often goes undetected in standard eye exams, making specialized diagnosis and treatment essential. If you’ve been to multiple doctors without relief, it might be time to consider that your symptoms stem from adult binocular vision dysfunction.

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Binocular Vision Symptoms & Causes

Living with untreated BVD as an adult can feel overwhelming. The misalignment of the eyes can cause a variety of visual symptoms (such as blurred vision) and other issues( such as dizziness and headaches) which are wide-ranging and often mimic other conditions, making diagnosis challenging.

Common Symptoms of Binocular Vision Dysfunction in Adults:

• Headaches or migraines, especially after reading or using a computer
• Dizziness, motion sickness, vertigo, or feeling unsteady while walking or driving
• Blurry or double vision
• Anxiety or panic in crowded or visually complex environments
• Eye strain or fatigue, particularly late in the day
• Neck or shoulder pain from head tilting (a  compensatory posture)
• Difficulty with depth perception or spatial awareness
• Reading challenges, including skipping lines or losing your place
• Light sensitivity

Causes of BVD in Adults:

• Congenital misalignment of the eyes (present since birth but worsens with age)
• Age-related weakening of eye muscles
• Concussions or traumatic brain injuries (TBIs)
• Neurological changes
  • Multiple sclerosis
• Significant visual demands (prolonged screen time or reading)

Risk Factors of BVD

Certain factors can increase the likelihood of developing or worsening Adult BVD:

• History of Concussions or TBIs: Even mild head injuries can disrupt visual alignment.
• Family History of Eye Misalignment: Subtle eye muscle issues tend to run in families.
• High Visual Demands: Jobs or activities requiring extended visual focus, like computer work or driving.
• Age-Related Changes: As we age, eye muscles can weaken, causing previously compensated misalignments to become symptomatic.
• Other Diagnosed Conditions: Diagnoses like ADHD, generalized anxiety disorder, migraines, or vestibular dysfunctions can mask or mimic BVD.
• Refractive Errors: Uncorrected refractive errors, such as astigmatism and anisometropia, can lead to blurred vision and visual discomfort, contributing to BVD.

Diagnosing BVD

Diagnosing binocular vision dysfunction in adults requires more than a standard eye exam. Most routine vision checks assess how clearly you see but don’t examine the nuanced eye alignment and coordination of your eyes.

Steps in Diagnosing Adult BVD:

1. BVDQ™ Screening Assessment – A quick symptom-based questionnaire that highlights the wide-ranging symptoms of visual misalignment.
2. NeuroVisual Evaluation – A comprehensive exam performed by a BVD specialist to assess eye coordination, alignment, and movement patterns. Unlike standard vision checks that primarily assess visual acuity, this evaluation focuses on the alignment and coordination of the eyes.
3. Eye Tracking Tests – These detect subtle disruptions in how your eyes follow or focus on objects.
4. Cover Tests – Evaluations that help reveal vertical or horizontal misalignment when one eye is covered.

If you suspect BVD, starting with the BVDQ™ Screening Assessment is a low-risk, high-reward option that can set you on the path toward answers and relief.

Binocular Vision Dysfunction Treatment

Most adults with BVD find meaningful relief through customized microprism glasses. These specialized lenses gently shift the image each eye sees, allowing for better visual alignment and reduced strain. While vision therapy is often recommended for binocular vision problems due to its focus on improving brain-eye communication and strengthening the visual system, it also comes with notable limitations — including high costs, a long timeline before seeing results (often 2–6 months), a lack of reliable screening to predict who will benefit, and the requirement for ongoing daily exercises.

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Primary Treatment: Prism Glasses

• Realign the visual images to improve coordination and prevent double vision
• Reduce the need for muscular compensation
• Provide fast relief from symptoms like dizziness, headaches, and anxiety

Additional Treatment Options:

• Lifestyle Adjustments: Minimizing screen time, improving posture, and modifying work environments
• Vision Therapy (in select cases):  In cases where prism glasses aren’t effective, it often suggests the eyes may not be the primary cause of symptoms. Our clinicians then conduct further testing to evaluate other systems like the ears, balance system, and autonomic nervous system, referring patients to the most appropriate specialists based on those findings.

Most patients report:

• Immediate or near-immediate symptom relief
• Better balance and focus, including significant relief from balance problems
• Improved productivity and reduced fatigue

Common Misdiagnoses

Because the symptoms of BVD overlap with many other conditions, including anxiety symptoms, it’s frequently misdiagnosed. Many adults with binocular vision problems receive treatments that only manage surface-level symptoms—or fail entirely.

BVD is commonly mistaken for:

• Migraine disorders
• Generalized anxiety disorder
• ADHD or focus disorders
• Chronic fatigue syndrome
• Vestibular or inner ear disorders
• Neck or musculoskeletal pain
• Convergence insufficiency

If you’ve been diagnosed with one of these but haven’t found consistent relief, it may be time to revisit the root cause—your vision.

Frequently Asked Questions About Adult BVD

1. How do I know if my symptoms are caused by BVD and not something else?

BVD symptoms often mimic other conditions like migraines or anxiety. If treatments for those diagnoses haven’t worked, and your symptoms align with BVD (headaches, dizziness, blurred vision, etc.), a specialized evaluation can help confirm or rule it out, and the BVDQ™ Screening Assessment can identify those who would most likely benefit from the specialized evaluation. BVD affects the brain’s ability to process visual information correctly, which can lead to problems with eye movement and alignment, further contributing to symptoms like headaches and dizziness.

2. Are there exercises you can do for BVD?

Yes, in some cases, vision therapy may be recommended. These exercises are designed to strengthen eye coordination, improve focus, and enhance how your eyes work together. Common exercises include:

• Pencil push-ups: Focusing on a small object as you move it toward your nose
• Brock string exercises: Using a string with beads to practice eye alignment
• Computer-based tracking activities: Programs that train eye movements and visual tracking

However, not all patients benefit from exercises. Many adults with BVD experience the best results with prism glasses, and exercises are typically used as a complementary therapy in select cases.

3. Can BVD develop later in life even if I’ve never had vision problems before?

Yes. BVD can develop as a result of aging, trauma, or changes in visual demand. As we age, one eye may become positioned physically higher than the other due to muscle weakening or other age-related changes. Even a mild head injury can trigger symptoms in adulthood.

4. Will standard glasses or contact lenses help with BVD?

Standard lenses may correct nearsightedness or farsightedness, but they do not address the subtle eye misalignment caused by BVD. Prism glasses are specifically designed to treat this condition by helping the eyes work together to achieve a single, clear image.

5. How soon will I notice results with prism glasses?

Many adults experience relief within minutes to days. Some symptoms improve immediately, while others resolve gradually as the brain adapts to better visual alignment. 

6. Is BVD treatment permanent?

While many patients enjoy long-lasting relief, BVD management may require ongoing care. Annual checkups ensure your prism glasses remain effective as your visual system changes. These checkups are part of the effective solutions that significantly improve patients’ quality of life and enhance visual comfort and functionality.

7. Can untreated BVD worsen over time?

Yes. Left untreated, BVD can significantly impact daily performance and quality of life, leading to increased headaches, worsening anxiety, and reduced overall functionality. Early diagnosis and treatment can prevent this progression.

8. Does insurance cover BVD testing and prism glasses?

Coverage varies by plan. Some insurance policies cover the exam and diagnostic testing, while specialty prism lenses may require out-of-pocket costs. It is important to consult specially trained eye doctors (NeuroVisual Specialists) for a proper diagnosis and treatment plan. They can conduct specific tests  to assess how well the eyes work together and provide tailored treatment plans that may include vision therapy and specialty lenses. The NeuroVisual Specialists’ staff can help navigate insurance questions.

Start Your Path to Relief 

If you’re struggling with symptoms that don’t go away—or haven’t responded to standard treatment—it’s time to consider BVD as the missing piece. BVD can significantly disrupt daily life, affecting common activities such as reading, driving, and even navigating crowded spaces. 

Stop struggling and start living. Take the test and schedule an appointment with a NeuroVisual Specialist.

Curious if you have Binocular Vision Dysfunction?

Take the assessment to get your score and get relief.

Learn more