What is Binocular Vision Dysfunction?
So, what is BVD? Have you ever wondered why, despite having two eyes, you only see one image? This is called binocular vision. Our brain is so intricate and complex that it’s able to turn two separate images into one clear image. For this to occur, the eyes need to be in in perfect alignment. In people who have good binocular vision, the eyes work in tandem and are perfectly in sync at all times, which allows them to send one clear, focused picture to the brain.
But when the eyes do not work smoothly together and are not perfectly synchronized, this is called Binocular Vision Dysfunction. People with BVD struggle to see one clear image. This leads to discomfort such as headaches, dizziness, double or overlapping vision, and even reading symptoms. Some even experience blurred vision and shadowed vision.
For people who have BVD, their eyes are not in alignment (not in sync) so their eyes will transmit two images to the brain that are in slightly different positions to one another. The brain won’t accept this situation and responds by forcing the eye-aligning muscles to fix the problem by realigning the eyes. The realignment is only temporary and misalignment then recurs, which is followed closely by realignment.
So there becomes a continuous cycle of image misalignment and realignment, which makes the brain believe things are moving, and as you can imagine, causes a great deal of eye muscle strain. The eyes become tired and sore, which can lead to a variety of unpleasant and sometimes painful symptoms, such as headaches caused by neck pain, chronic neck pain, shoulder pain, and face and eye pain while making eye movements. People with BVD may also experience difficulty concentrating and anxiety symptoms.
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The 3 Components of Binocular Vision
Binocular vision is typically divided into three components: macular perception, fusion, and stereopsis.
1. Macular Perception
Macular perception is the most basic component of binocular vision. It is the ability of the brain to perceive images from both eyes with the macula, the central part of the retina responsible for sharp, detailed vision. At this stage, the brain recognizes and processes the input from both eyes but does not yet merge the two images into a single, unified picture. This level of vision is fundamental for further development of binocular functions. A lack of macular perception can lead to conditions like double vision (diplopia).
2. Fusion
Fusion is the second component of binocular vision and involves the brain’s ability to merge the two images from each eye into a single coherent image. This process occurs at two levels:
- Motor Fusion: This is the physical alignment of the eyes so that the images fall on corresponding retinal points. It is controlled by the eye muscles and involves adjusting the position of the eyes to ensure that both are aimed at the same point in space.
- Sensory Fusion: This is the neurological process where the brain merges the images received from both eyes into one. Sensory fusion relies on the proper alignment achieved by motor fusion and is essential for clear, single vision. Disruptions in sensory fusion can cause visual discomfort and disorders like convergence insufficiency.
3. Stereopsis
Stereopsis, or stereoscopic vision, is the most detailed expression of binocular vision. It is the brain’s ability to perceive depth based on the slight differences between the images seen by each eye. These differences, known as binocular disparities, arise because each eye views an object from a slightly different angle. The brain processes these disparities to create a three-dimensional perception of the world. Stereopsis is crucial for tasks requiring depth judgment, such as catching a ball, driving, or navigating through complex environments.
Vision Specialist’s Dr. Rosner Explains Binocular Vision Dysfunction
Causes of Binocular Vision Dysfunction
Commonly confused with sinus issues and migraines, BVD can develop due to an abnormal visual system as a result of a stroke, brain injury, concussion, or similar neurological disorder. It can manifest at any time, with symptoms usually developing around 40 years of age.
Facial asymmetry, where one eye is physically higher than the other one (see Figure 1 below) can also be a factor in causing this condition. Facial asymmetry or a nerve or eye muscle abnormality is something many people are born with. Over time, these individuals often start to develop BVD as the eye muscles get weaker with age and become overworked.
1. Facial Asymmetry
Many people with Binocular Vision Dysfunction will try to improve their vision (and reduce their symptoms) by tilting their heads. VICE recently published the article, A Stranger Diagnosed Me With Misaligned Eyes, where the author recounts her experience living with BVD, including this iconic head tilt.
When the head is tilted to the side toward the shoulder, images move down in one eye and up in the other. While tilting the head does help fix the misalignment, it can also lead to severe neck pain and headaches caused by neck pain.
2. Strabismus
Strabismus, commonly known as crossed eyes or wandering eyes, is a condition where the eyes do not align properly. One or both eyes may turn inward, outward, upward, or downward. This misalignment disrupts the coordination between the eyes, leading to problems with fusion and stereopsis.
3. Refractive Errors
Uncorrected refractive errors, such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, can cause the eyes to focus differently. When one eye has a significantly different prescription than the other (anisometropia), it can lead to difficulties in merging the two images, causing visual discomfort and double vision.
4. Convergence Insufficiency
Convergence insufficiency is a condition where the eyes have difficulty working together while focusing on a nearby object. This condition can cause symptoms such as headaches, eye strain, and difficulty reading. It occurs when the eyes do not converge properly, resulting in poor motor fusion.
5. Neurological Disorders
Certain neurological disorders can affect the control and coordination of eye movements. Conditions such as multiple sclerosis, stroke, and traumatic brain injuries can damage the nerves responsible for eye movements, leading to BVD.
6. Developmental Issues
Developmental issues during childhood can impact binocular vision. For example, children with amblyopia (lazy eye) may develop BVD if the condition is not treated early. Amblyopia occurs when one eye is weaker than the other, leading to poor visual development in the affected eye.
7. Eye Muscle Problems
Weakness or paralysis of the eye muscles can lead to BVD. Conditions such as cranial nerve palsies or myasthenia gravis can affect the muscles controlling eye movements, making it difficult for the eyes to align properly.
8. Injuries
Trauma to the head or eyes can disrupt the alignment and coordination of the eyes. Injuries can damage the muscles, nerves, or structures within the eye, leading to difficulties in maintaining proper binocular vision.
9. Genetic Factors
Some individuals may have a genetic predisposition to BVD. Certain genetic conditions can affect the development and function of the eyes and the visual system, leading to issues with binocular vision.
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Common Symptoms of Binocular Vision Dysfunction
When you have Binocular Vision Dysfunction, the list of possible binocular vision symptoms can feel endless. Some people experience a handful of symptoms, while for others, it’s more like fistfuls, completely disrupting their lives and resulting in disability. Some of the core symptoms are blurry vision, motion sickness, eye pain, light sensitivity, double vision, overlapping vision, and poor depth perception. But many other symptoms exist and can include:
- Visual Vertigo: A sensation of dizziness or spinning triggered by certain visual stimuli.
- Restless Sleep Pattern: Difficulty sleeping or experiencing an irregular sleep pattern due to discomfort caused by BVD.
- Migraine Disorder: Frequent and severe headaches often accompanied by other sensory disturbances.
- Head Tilt or Turn: A tendency to tilt or turn the head to one side to alleviate visual discomfort or to try to improve vision.
- 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. Having difficulty focusing is also a common sign.
- Eye Strain and Fatigue: Experiencing tired or sore eyes, especially after prolonged visual tasks such as reading or using a computer.
Misdiagnoses Related to BVD
Doctors cannot diagnose binocular vision dysfunction through standard eye tests because those tests are not sensitive enough to find the very small amount of misalignment that is causing the symptoms. With such tests, both eyes may appear to be functioning correctly. Unless a doctor finds a significant misalignment, they will likely dismiss vision problems as the root cause of symptoms.
It’s common for people to have been diagnosed with a myriad of other conditions, then find out that Binocular Vision Dysfunction was the true culprit. These other conditions include:
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How To Distinguish BVD From Other Conditions
It can be challenging to determine if you have BVD, and in many cases, the best approach is to start by ruling out other serious diagnoses. Once that has been accomplished, if the cause of the symptoms is still uncertain, there are questions that should be asked. If you answer “yes” to one or more of these questions, your primary care physician or ophthalmologist/optometrist should be asked about the possibility of having binocular vision dysfunction:
- Have you seen at least one specialist who could not help with your pain, dizziness, poor depth perception, light sensitivity, or other symptoms, or who told you that there is nothing wrong with you despite your persistent symptoms?
- Have you been diagnosed with one of the conditions that can often be confused with BVD?
- Did you suffer a concussion or traumatic brain injury, and now your symptoms won’t go away?
If you suspect that you have BVD, you should talk to your eye doctor immediately, as this condition will worsen with time. Make sure you come prepared with a complete list of your symptoms, how long they have persisted, and why you believe the problem is related to BVD and not to another neurological condition.
Additionally, you may wish to take the Binocular Vision Dysfunction Questionnaire (BVDQ), which can identify those who may have BVD and who would benefit from a NeuroVisual Evaluation.
Prism Glasses: 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 prism glasses. Prism glasses are more efficient and frequently more effective than vision therapy in most cases.
Understanding Prism Lenses
Prism glasses are specially designed eyeglasses that incorporate prismatic lenses. 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.
The Role of a NeuroVisual Evaluation
To effectively determine the right prescription for prism glasses, it is crucial to undergo a NeuroVisual Evaluation. This specialized examination is performed by eye doctors with expertise in diagnosing and treating BVD. During the exam, the doctor will assess the extent of misalignment in your eyes and precisely identify the amount of prism correction needed to reduce symptoms.
How Prism Glasses Work
Once the results of the NeuroVisual Evaluation are obtained, the eye doctor can prescribe prism 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, prism glasses enable your brain to easily fuse them into one clear, focused image.
Benefits of Prism Glasses
Prism glasses offer several advantages for individuals with BVD, including:
- Relief from Symptoms of BVD: Prism glasses can significantly reduce or even completely eliminate symptoms such as headaches, dizziness, double or overlapping vision, and eye strain.
- Improved Comfort: By aligning the images correctly, prism glasses reduce the constant cycle of misalignment and realignment in your eyes, preventing eye muscle strain and discomfort.
- Enhanced Daily Functioning: With the help of prism glasses, many individuals find that they can go about their daily activities more comfortably and with improved clarity of vision.
- 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. Prism glasses can alleviate this strain, promoting better neck posture.
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Let’s Treat Your Binocular Vision Dysfunction
Are you familiar with some of these symptoms? If so, we provide a free online binocular vision dysfunction test to help you learn more about your symptoms and determine whether you should seek an appointment for a NeuroVisual Evaluation. At Vision Specialists of Michigan, 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 Vision Specialists eye doctor and corrected using specialized realigning eyeglasses. These specialized microprism lenses fix the misaligned images by bending the light beam entering the eye. With the images realigned, the brain can easily make a single three-dimensional image, relieving eye strain, eye muscle problems, and other BVD symptoms.