BVD & NeuroVisual® Medicine

Have you ever experienced dizziness, vertigo, motion sickness, blurred vision or anxiety in large crowds or open spaces? Have you ever had panic attacks while driving, or stopped driving altogether due to discomfort? Do you experience neck tension, stiff shoulders, frequent headaches, or migraines. Did you ever had strange sensations while driving, such as feeling like the car is moving backward when it isn’t, or like the floor is shifting beneath even though it’s not, yet your eye doctor says your eyesight is perfectly fine? If so, you might be dealing with a condition called Binocular Vision Dysfunction, or BVD which is a lesser-known visual problem that affects how both eyes work together.

What is Binocular Vision Dysfunction (BVD)?

Binocular Vision Dysfunction occurs when your eyes are slightly misaligned, meaning they don’t work together in perfect harmony. Each eye may see clearly on its own, but together, they send two slightly different images to the brain. The brain then has to work hard to “fuse” these images into one.

This constant effort can overwhelm your visual system, leading to a wide range of physical, visual, and even emotional symptoms, many of which often go misdiagnosed or misunderstood. Surprisingly, even slight eye misalignments that go undetected in a routine eye exam can still cause noticeable symptoms.

What Causes Eye Misalignment?

Your eyes are controlled by muscles that help them move in sync. If one of these muscles is slightly stronger, weaker, or not functioning properly, a tiny misalignment can occur.

This might be due to:

• Congenital or developmental issues like facial asymmetry, strabismus etc.

• Genetic factors

• Concussions or traumatic brain injuries

• Stroke or neurological conditions

Signs and Symptoms of BVD

Binocular Vision Dysfunction doesn’t present in just one way. It’s a complex condition with a wide array of symptoms that may include:

Visual Symptoms:

• Blurry or double vision

• Difficulty seeing clearly in dim environments

• Trouble with depth perception

• Visual fatigue, especially after reading or screen use

• Sensitivity to light or glare

• Sore eyes or strained eyes

Reading Symptoms:

• Struggles with reading fluency or accuracy

• Becomes easily fatigued while reading

• Frequently skips lines of text

• Tends to cover one eye while reading

• Reports that words appear to blur or run together

• Often needs to reread passages to understand the content

Neurological Symptoms:

• Migraine disorder

• Headaches (especially behind the eyes or forehead)

• Vertigo

• Seizures

Physical Symptoms:

• Dizziness or unsteadiness

• Balance and coordination issues

• Motion sickness

• Neck or shoulder pain due to head tilt/neck tilt (from posture compensation)

Cognitive and Psychological Symptoms:

• Difficulty concentrating or focusing

• Agoraphobia

• Panic attacks

• Anxiety with driving, particularly on highways

• Shows reduced ability to maintain eye contact

• Overwhelm in crowds

• Restless sleep pattern

​​​​​​​Many people with BVD are initially misdiagnosed with conditions like migraines, dyslexia, ADHD, anxiety disorders, or inner ear problems because their symptoms overlap.

Treatment Options for BVD

Binocular vision dysfunction encompasses several types, including Vertical Heterophoria (VH), Superior Oblique Palsy (SOP), Inferior Oblique Palsy, Esophoria, Exophoria, and Convergence Insufficiency. Each type requires a slightly different approach to treatment. Fortunately, these conditions can be successfully managed with the appropriate treatment, most individuals report noticeable improvements, and many experience substantial relief.

One of the great advantages of this testing is that, often during the exam, you’ll be able to tell if our Neuro Visual treatment will benefit you. Once Dr. Kanukuntla determines the precise amount of prism needed, she will create a pair of demo lenses for you to wear during your appointment. Many patients’ experiencing dizziness and headaches report feeling a 50% reduction in their symptoms within just 10 to 20 minutes of wearing the demo glasses and 80% improvement within 4-6 weeks. While some notice immediate relief, others may require additional time to fully adjust.

Microprism Lenses

The most common treatment is microprism glasses, which are specially customized based on individual measurements during the exam. These microprism lenses slightly alter the path of light entering your eyes. This adjustment helps align the images from each eye, making it easier for your brain to combine them.

Patients often report almost instant relief after trying on their first pair of customized lenses.

Who Can Develop BVD?

BVD can affect people of all ages, from children who are learning to read to adults coping with daily work pressures or recovering from a concussion. Children who are affected typically have the congenital or developmental form of BVD and often misdiagnosed with ADHD or learning disorders. Teens might struggle with schoolwork, especially reading and computer-based tasks, Hand-eye coordination, participation in sports, and motion sickness.

Adults are most commonly impacted by either: A congenital/developmental form that begins to show symptoms in mid-life (often around age 40) like trouble driving, focusing at work, or managing daily tasks or a concussion or brain injury that triggers the condition later in life.

Recognizing BVD Among Other Conditions

Many people receive diagnoses for a variety of conditions before discovering that Binocular Vision Dysfunction (BVD) is the actual underlying cause. Identifying BVD can be challenging and often involves first ruling out other serious medical issues. If your symptoms continue without a clear explanation, consider whether you or your healthcare providers have explored the possibility of BVD.

Common underlying conditions that may lead to BVD include:

• Post-Concussion Syndrome

• Cervical Spine Misalignment

• Meniere’s Disease

• Multiple Sclerosis (MS)

• Stroke

• Traumatic Brain Injury (TBI)

• TMJ (Temporomandibular Joint) Disorders

• Ehlers-Danlos Syndrome (EDS)

Misdiagnosis of BVD

BVD is often misdiagnosed as one of the following conditions before the true cause is identified:

• ADHD/ADD

• Agoraphobia

• Anxiety or panic disorders

• BPPV (Benign Paroxysmal Positional Vertigo)

• Chronic Dizziness

• Chronic Sinus Issues

• Dyslexia

• General Migraines/Ocular Migraines

• Learning and Reading Disabilities

• PPPD (Persistent Postural-Perceptual Dizziness)

• Vestibular Migraine / Migraine-Associated Vertigo (MAV)

Why Getting the Right Diagnosis Matters

Living with undiagnosed BVD can be exhausting. It affects not just how you see, but how you function in daily life. You might feel clumsy, anxious, or constantly drained without ever realizing your eyes are the cause.

Getting the right diagnosis can lead to effective treatment that truly makes a difference. Whether it's finding relief from chronic headaches or finally being able to read comfortably for more than five minutes, recognizing and addressing BVD can greatly enhance your quality of life of life.

If your symptoms persist, and doctors can’t explain or treat issues like dizziness, pain, or light sensitivity, it may be time to explore further and get a BVD evaluation.
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Migraines and Headaches

Migraines are a complex neurological condition characterized by recurring episodes of moderate to severe head pain. Unlike typical headaches, migraines often involve additional sensory and neurological symptoms that can significantly interfere with daily life. Episodes may last from several hours to multiple days and can vary in intensity and frequency. Migraines are affecting approximately 12% of the population, with women three times more likely to experience them than men.

Common Migraine Symptoms and Triggers

Migraine symptoms extend beyond head pain and may include:

• Throbbing or pulsating headache, often on one side of the head

• Sensitivity to light, sound, or visual movement

• Nausea and vomiting

• Dizziness or a sensation of imbalance

• Visual disturbances such as blurred vision, shimmering lights, or blind spots

• Difficulty concentrating or mental fatigue

• Neck and shoulder tension
  
  

Some individuals experience visual changes before or during a migraine episode, commonly referred to as a visual aura. These symptoms can make reading, screen use, driving, and navigating busy environments especially difficult.

Migraines may be triggered by stress, hormonal changes, sleep disruption, certain foods, environmental stimuli, or prolonged visual demands. In many cases, individuals continue to experience lingering symptoms, such as light sensitivity, dizziness, or eye strain even between migraine episodes.

Binocular Vision Dysfunction (BVD): An Overlooked Contributor

When migraines persist despite medication or lifestyle adjustments, it is important to consider additional contributing factors, including the role of the visual system. For many individuals, visual system dysfunction plays a significant and often overlooked role. Binocular Vision Dysfunction (BVD) occurs when the eyes do not work together properly, creating visual strain that can contribute to headaches, dizziness, and migraine-like symptoms.

Understanding the connection between migraines, headaches, and binocular vision can help identify underlying causes that routine evaluations may miss.

How BVD Can Contribute to Headaches and Migraine-Like Symptoms

When the visual system is misaligned, the brain receives inconsistent visual input. To correct this, it must constantly adjust eye position and focus. Over time, this visual stress may contribute to symptoms commonly associated with migraines, including Frequent headaches or migraine-like pain, dizziness, balance difficulties, Light sensitivity, Nausea, Difficulty reading or concentrating and Eye strain that worsens throughout the day.

Because these symptoms overlap with migraine symptoms, binocular vision dysfunction may go unrecognized as an underlying contributor.

Why BVD is often Missed and How to diagnose and Manage Binocular Vision Dysfunction

Traditional eye exams focus primarily on visual clarity and eye health. While essential, these exams do not typically evaluate how well the eyes coordinate under real-world visual stress. Subtle alignment issues and eye teaming problems require specialized testing to detect.

Our neurovisual specialist at Focus on Eyes evaluates how the eyes and brain work together through a comprehensive neurovisual (binocular vision) examination. This assessment includes detailed analysis of:

• Eye alignment and coordination

• Focusing ability and visual endurance

• How the eyes respond to visual stress and movement

• The connection between the visual and vestibular systems

• Analysis of how visual input interacts with balance systems

When BVD is identified, treatment is typically non-invasive and individualized. Options may include custom prism lenses to realign visual input and reduce strain. Many individuals experience immediate improvement in visual comfort, headache frequency, dizziness, and overall quality of life once the visual system is properly supported.

When to Consider a Neurovisual Evaluation

You may benefit from a binocular or neurovisual assessment if you experience:

• Migraines or headaches triggered by reading, screen use, or driving

• Persistent dizziness or motion sensitivity

• Eye strain that increases throughout the day

• Neck pain associated with visual tasks

• Difficulty tolerating visually busy environments

• Limited relief from standard migraine treatments

A More Complete Approach to Migraine and Headache Care

Migraines and headaches are multifactorial conditions, and not all symptoms are vision-related. However, binocular vision dysfunction can be a contributing factor that is often overlooked.

At Focus on Eyes, we understand how frustrating it can be to live with constant headaches and visual discomfort. Our goal is to uncover the hidden visual causes behind your symptoms and provide gentle, effective solutions that improve both comfort and quality of life.

Don’t let headaches and migraines hold you back. Schedule a Binocular Vision Dysfunction (BVD) evaluation at Focus on Eyes today and discover how a simple change in how your eyes work together can transform how you feel every day.