Frequently Asked Questions

Vertical Heterophoria

Question

Answer

· A. What is Vertical Heterophoria?

Vertical Heterophoria is a condition where one eye sees the image higher than the other eye. Sometimes one eye is physically higher than the other. Sometimes the eyes are aligned correctly but muscle or nerve abnormalities cause the problem.

· B. What are the symptoms of Vertical Heterophoria?

The most common symptoms are headaches and dizziness. The headaches are
usually in the front of the face or in the temples. The dizziness is described as a feeling of being disoriented, lightheaded or dizzy. Those who suffer from Vertical Heterophoria may also have other symptoms in addition to those of headaches and dizziness. These include:

pain symptoms such as face ache, eye pain or pain with eye movement (symptoms similar to sinus problems, migraines, TMJ problems); neck ache and upper back pain due to a head tilt (similar to spinal misalignment symptoms);
balance and coordination symptoms such as motion sickness, nausea, poor depth perception, unsteadiness while walking or drifting to one side while walking (“I’ve always been clumsy”), lack of coordination (symptoms are similar to those seen in patients with MS, sequela of a stroke, an inner ear disorder or Meniere’s Disease);
reading symptoms such as difficulty with concentration (symptoms are similar to those experienced with ADHD), difficulty with reading and comprehension, skipping lines while reading, losing one’s place while reading, words running together while reading (symptoms similar to those seen with a learning disability);
vision symptoms such as blurred vision, double or overlapping vision, shadowed vision (symptoms similar to those seen in patients with MS); light sensitivity, difficulty with glare or reflection;
psychological symptoms such as feeling overwhelmed or anxious when in large contained spaces like malls or big box stores like Wal Mart, feeling overwhelmed or anxious in crowds or with driving (symptoms similar to those seen in patients with anxiety or agoraphobia).

· C. How is Vertical Heterophoria treated?

Vertical Heterophoria is treated by correcting the eye misalignment. To accomplish this, the optometrist will add prism to your glasses. The prism will bend light in such a way that the image seen by the eye is moved into the position it needs to be, in order to once again realign the eyes. Once this occurs, the muscles no longer have to strain, and the headaches, dizziness, blurred vision and other symptoms resolve.

· D. Can Vertical Heterophoria cause me to be anxious?

Yes. People become anxious in crowds or large spaces, or with driving. Some people say the dizziness itself causes them to be anxious.

· E. Can Vertical Heterophoria make it difficult for me to drive?

Yes. Depth perception is affected, as is the sense of balance and equilibrium, all of which make it difficult to drive.

· F. How do you get Vertical Heterophoria?

Most often this is a condition you are born with (congenital). It may take years before symptoms occur, as the body will do the best it can to try and compensate for these problems. In some patients, this condition may be caused by head trauma, stroke, or neurological disorders.

There have been a number of patients who have developed VH (or had their VH worsened) due to a motor vehicle collision or other jarring incident (like falling) without documentation of a TBI. While the etiology of the VH in these situations is unclear, it is clear that the VH was precipitated (or worsened) by the incident because the symptoms started (or pre-existing symptoms were worsened) immediately after the incident.

· G. Does this condition tend to run in families?

Yes. This condition tends to run in families.

· H. How is the diagnosis of Vertical Heterophoria made?

There are many causes of dizziness, headache and blurred vision. The first step in diagnosing VH is to be certain that the symptoms aren’t actually being caused by another condition. The person should be evaluated by their own physician and / or specialists, and if no cause for the persons’ symptoms is found, then it may be that VH is the cause of their symptoms:

The person is administered a specialized questionnaire that has been designed by Dr. Debby Feinberg to help diagnose those who have VH as a cause for their symptoms of dizziness, headache and blurred vision.
The person fills out a detailed Health History form.
An Optometric exam is performed to determine the need for correction of nearsightedness, farsightedness and astigmatism.
A specialized exam is performed to determine if visual misalignment is present.
The person is fitted with a trial version of their new prescription. Most people notice a significant improvement in their symptoms within 20-30 minutes of putting on the trial lenses.

· I. How does eye misalignment make me have symptoms?

Eyes that are misaligned cause blurred or double vision. The brain does not tolerate blurred or double vision, so it forces the eyes to look at the exact same spot, so that only one image is seen. This is accomplished by straining the eye muscles to make one eye look up a little more, and the other eye to look down a little more. Over a long period of time, the straining of the eye muscles causes the pain symptoms of Vertical Heterophoria. As the muscles strain, they become fatigued and jittery, and can no longer keep the eyes in the correct alignment. This “bouncing” in and out of alignment creates the feeling of dizziness, lightheadedness, vertigo and a sense of imbalance.

Take the test on the right and find out if this is what is happening to you.

All the best to you, Yolanda