Binocular Vision Dysfunction (BVD) is a visual condition where the eyes are not perfectly aligned, causing significant strain as the eye muscles work overtime to correct the misalignment. This constant effort to maintain clear, single vision can result in discomfort and a range of symptoms. BVD may be a condition someone is born with, or it can develop after a traumatic brain injury, such as a concussion.
What Is Binocular Vision Dysfunction?
One of the most common forms of BVD is Vertical Heterophoria, a condition where one eye is slightly higher than the other. This vertical misalignment can lead to severe eye strain and numerous related symptoms.
What Are the Symptoms of BVD?
BVD symptoms often stem from the brain’s attempts to compensate for misaligned eyes. When the eye muscles are overworked to bring the eyes into alignment, it leads to strain, fatigue, and discomfort. These symptoms can vary in intensity and include physical, visual, and even emotional effects. Some of the most common symptoms experienced by individuals with BVD include:
Visual Symptoms
- Double vision
- Blurred or shadowed vision
- Words appearing to move on a page while reading
- Skipping lines or losing your place while reading
- Difficulty with depth perception
Physical Symptoms
- Headaches or migraines
- Dizziness or lightheadedness
- Neck, upper back, or shoulder pain
- Eye pain, especially when moving the eyes
- Fatigue and difficulty concentrating while reading
Balance and Coordination Issues
- Poor balance or drifting while walking
- Feeling clumsy or uncoordinated
- Sensation of floating
Emotional and Other Symptoms
- Anxiety in crowded spaces or large open areas
- Motion sickness or nausea
- Sensitivity to light and glare
- Feeling disoriented or dizzy while driving
- Sensation of movement when stationary, such as at a traffic light
If any of these symptoms sound familiar, you may have Vertical Heterophoria or another type of Binocular Vision Dysfunction. These symptoms can significantly affect your quality of life, but they are treatable. To better understand if you may have BVD, we encourage you to complete our BVD Questionnaire. Once you’ve submitted your responses, our team will analyze your results and contact you to discuss your symptoms and potential next steps.
Why Choose NeuroVisual Specialists of Florida and iSee VisionCare?
At NeuroVisual Specialists of Florida and iSee VisionCare, we specialize in diagnosing and treating Binocular Vision Dysfunction, including Vertical Heterophoria. Our practice is proud to be the first neurovisual specialist in Florida, offering comprehensive eye care services to individuals of all ages.
In addition to addressing BVD, our clinic provides:
With a compassionate and expert team, we’re dedicated to improving your vision and enhancing your overall quality of life. Whether you need a routine check-up or specialized care for BVD, we’re here to help.
Contact Us Today!
Don’t let the symptoms of Binocular Vision Dysfunction disrupt your life. Contact NeuroVisual Specialists of Florida and iSee VisionCare today for expert diagnosis and treatment.
Call us at (561) 733-9008 or reach out through our online contact form to schedule your appointment. Let us help you regain clarity, comfort, and confidence in your vision.
Frequently Asked Questions
Dilation is typically performed during a follow-up visit rather than the initial BVD evaluation. However, if you have not been dilated in the last year, Dr. Sonneberg may recommend it sooner. Your comfort and consent remain our top priorities.
Modern prism glasses look just like regular eyewear. The prism is built into the lens in a way that is subtle, discreet, and cosmetically appealing. In most cases, people will never know you’re wearing prism correction.
For a visual explanation, here is a helpful video:
Prism Glasses Explained: https://www.youtube.com/watch?v=1NVe2hC82Ug
Most patients receive prism correction in glasses, which offer the best stability and clarity. In select cases, prism can be incorporated into contact lenses — typically for special events or specific use cases. Dr. Sonneberg will guide you based on your individual needs.
Not necessarily. Every patient is different. Some people wear prism full-time long-term, while others may need adjustments or may eventually require less prism over time. Your long-term need will depend on your visual system, your symptoms, and Dr. Sonneberg’s clinical findings.
Before the end of your evaluation, she will discuss your personalized treatment plan and expected outcomes.
BVD symptoms vary widely, which is why the condition is often mistaken for issues like anxiety, migraines, or sinus problems. Common symptoms include:
- Frequent headaches or migraines
- Dizziness or unsteadiness
- Light sensitivity
- Difficulty reading or concentrating
- Eye strain or fatigue
- Motion sickness or car sickness
- Anxiety in large stores or crowded environments
- Feeling “off balance” or “tilted”
- Neck pain or head tilt
- Double vision or intermittent blurry vision
If you’ve seen multiple specialists without answers, BVD may be an underlying cause.
Very small misalignments of the eyes — often as tiny as 0.25 diopters — can create powerful symptoms throughout the visual and vestibular system. Because these misalignments are subtle and not typically detected in a standard eye exam, patients are frequently misdiagnosed with:
- Chronic migraines
- Vestibular disorders
- Anxiety
- Sinus issues
- Vertigo
- Concussion after-effects
- ADHD in children
Dr. Sonneberg’s NeuroVisual method is specifically designed to detect these micro-misalignments.
Dr. Sonneberg uses an advanced, specialized diagnostic process developed under the training of Dr. Debby Feinberg, the nation’s leading expert in NeuroVisual Optometry.
Your evaluation may include:
- A detailed symptom assessment
- Neurovisual alignment testing
- Prism challenge testing
- Ocular motor and tracking analysis
- Visual processing evaluation
Most patients experience noticeable improvement during the exam when prism lenses are introduced — one of the most distinctive features of NeuroVisual Optometry.
Yes. BVD can be:
- Congenital (present since childhood)
- Developmental (emerging during adolescence or adulthood)
- Post-traumatic (triggered by a concussion, TBI, car accident, or whiplash)
Many patients begin experiencing symptoms months or even years after a head injury.
Many patients feel significant improvement within minutes of wearing their trial prism lenses during the exam. Others may experience gradual improvement over days to weeks as the brain adapts to the new, corrected visual input. Follow-up visits are scheduled to ensure optimal results.
Standard eye exams are designed to identify:
- Refractive errors (nearsightedness, farsightedness, astigmatism)
- Eye health concerns (cataracts, glaucoma, etc.)
They do not evaluate for the subtle binocular misalignments responsible for BVD and VH.
NeuroVisual Optometry uses specialized testing techniques, equipment, and prism evaluation methods not included in a routine exam.
