Debby L. Feinberg1, Mark S. Rosner1,2, Arthur J. Rosner3
1Vision Specialists Institute, Bloomfield Hills MI 2St. Joseph Mercy Hospital, Ann Arbor, MI 3The Oakland University William Beaumont School of Medicine, Rochester, MI
Presented as a poster at the American Academy of Optometry Annual meeting, Anaheim, California, November 10, 2016
Headache, dizziness and anxiety are common medical problems with significant impact on individual patients as well as society as a whole.
- Active general headache disorders impact 46% of the population
- Dizziness impacts over 20%
- Anxiety disorders impact between 7-16%
The diagnosis and treatment of headache, dizziness and anxiety is usually approached individually since no single entity is routinely ascribed to be causative of all three symptoms. However, many patients are refractory to or fail standard treatment and/or therapeutic modalities that target symptoms individually.
Vertical heterophoria (VH), a form of binocular vision dysfunction (BVD), can trigger all three symptoms. However, this is not known by the majority of those in the medical and vision communities, and VH is rarely considered as a possible etiology for many reasons including:
- The VH/BVD symptom set is expansive and diverse, and the individual symptoms are common to many medical conditions11,14-20(Figure 1)
- Traditional BVD symptoms like diplopia and blurred/overlapping images are not present in the majority of these patients15,21
- Lack of sensitivity of the current diagnostic tests (associated and dissociated phoria tests) in identifying VH11,13,22-26
- Lack of a screening questionnaire that incorporates all the symptom domains that are associated with VH/BVD
Our investigation into VH/BVD began in 1995 and to date over 8000 patients have been evaluated and treated with our techniques, and anecdotally patients have experienced marked reduction in their headache, dizziness and anxiety symptoms. The purpose of this study is to document the efficacy of neutralizing prismatic lenses for reduction of headache, dizziness and anxiety in patients diagnosed with vertical heterophoria (VH) using our techniques.
To view additional introduction, methodology and full results information, please refer to the attached article (Link Below)
- Using the Prism Challenge technique, prism application to neutralize VH markedly reduced all measures of headache, dizziness and anxiety (22.3%-60.8%) and an overall 78.0% subjective reduction of VH symptoms (Figure 3)
- Ophthalmology evaluation occurred in 42.9%, optometry evaluation occurred in 30.2%, and both occurred in 56.3% of patients, yet no patients were diagnosed with or treated for VH (Figure 4)
- The three most common presenting complaints in this group of VH patients was headache (32.5%), dizziness (32.5%) and neck pain (11%). Blurred/doubled vision was the presenting complaint in 1.6%
- Vertical alignment tests predicted the direction of the misalignment between 25.0%-53.7% of the time, while the observed direction of the head tilt predicted the direction of the misalignment 74.6% of the time (Figure 5)
- Mean / median cumulative vertical prism prescription was 1.66 and 1.5 diopters respectively
- Vertical prism prescription between 0.5 and 2.00 diopters was noted for 76.2% of the patients,
between 2.50 and 4.00 diopters for 21.4%, and greater than 4.00 diopters for 2.4% (three patients)