Vertical Heterophoria

Vertical Heterophoria (VH) is a type of Binocular Vision Dysfunction (BVD) caused by a vertical misalignment between the eyes. This misalignment forces the eye muscles to work constantly to align your vision, resulting in strain on the visual system. Over time, this strain leads to symptoms such as dizziness, headaches, eye strain, and even motion sickness.

Figure 1: adapted from: vision-specialists.com,
Source: https://eyesoneyecare.com/resources/what-is-vertical-heterophoria/

Symptoms of Vertical Heterophoria

Symptoms of Vertical Heterophoria (VH) can vary widely but often include:

Frequent Headaches or Migraines – Due to constant strain from eye misalignment.
Dizziness and Balance Issues – Difficulty maintaining balance or feelings of unsteadiness, especially when moving or focusing on objects.
Motion Sickness or Seasickness – Sensitivity to motion in vehicles or on screens.
Eye Strain and Fatigue – Eyes tire easily, especially during reading or prolonged screen use.
Double Vision or Blurred Vision – Trouble focusing on a single clear image.
Light Sensitivity – Increased sensitivity to bright lights, which can worsen other symptoms.
Anxiety in Crowds or Busy Environments – Overstimulation due to visual processing difficulties.
Neck and Shoulder Pain – Resulting from compensating head positions to align vision.

These symptoms often worsen with tasks that require intense focus or visual concentration, such as reading or driving, and can significantly impact daily life.

Binocular Parallax

Because our eyes see the world from slightly different locations, images sensed by each eye are slightly different. This difference is called binocular parallax. The human visual system is very sensitive to these differences and binocular parallax is the most important depth cue for medium-viewing distances. A sense of depth can be achieved using binocular parallax even if all other depth cues are removed.

Monocular Movement Parallax

If we close one of our eyes, we can perceive depth by moving our head. This happens because the human visual system can extract depth information from two similar images sensed one after the other in the same way that it can combine two images from different eyes.

Retinal Image Size

When the real size of the object is known, our brain compares the sensed size of the object to this real size. This retinal image gives us information about the distance of the object.

Linear Perspective

When looking down a straight level road we see the parallel sides of the road meet in the horizon. This linear perspective effect is often visible in photos and it is an important depth cue.

Texture Gradient

The closer we are to an object the more detail we can see of its surface texture. That’s why objects with smooth textures are interpreted as being farther away. This is especially true if the surface texture spans the entire distance from near to far.

Overlapping

When objects block each other out of our sight, we know that the object that blocks the other one is closer to us. The object whose outline pattern looks more continuous is felt to lie closer.

Aerial Perspective

The mountains on the horizon always look slightly bluish or hazy. The reason for this is small water and dust particles in the air between the eye and the mountains. The farther the mountains, the hazier they look.

Shades and Shadows

When we know the location of a light source and see one object casting a shadow on other objects, we understand that the object casting the shadow must be closer to the light source. As most illumination comes downward, we tend to resolve ambiguities using this information. Three-dimensional computer interfaces are an example of this. That’s also why brighter objects seem to be closer than darker ones.

Enhancing Binocular Vision

In most cases, the information needed to accurately perceive an environment is available but has not been properly assimilated by the binocular vision system.

However, through neuro visual training it is possible to hone these binocular processing activities in order to improve spacial judgment, sports performance, and skills useful for navigating everyday life.

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How We Help with Vertical Heterophoria

If you or a loved one is experiencing symptoms of Vertical Heterophoria, contact us for a consultation. Even if you’ve been told that the issues are due to stress, developmental delays, or will improve over time, having a functional visual evaluation can help identify vision problems as a root cause or contributing factor.

Not every optometrist is trained in addressing Vertical Heterophoria through vision therapy. At Opto-Mization, we specialize in this field and use the latest technology to provide comprehensive care. Our expertise ensures that we can effectively assess and treat Vertical Heterophoria, helping to improve visual function and overall quality of life.

Schedule a consultation with us today to explore how our customized vision therapy can support you or your loved one in overcoming Vertical Heterophoria.

We have the expertise and latest technology to provide you with the top-level care you deserve.

How Long Does Treatment Take?

No two patients are alike—each person experiences Vertical Heterophoria uniquely. Some individuals may require just a few weeks of vision therapy, while others may need more long-term treatment. The good news is that the improvements achieved through our vision therapy program are generally long-lasting, helping to significantly enhance overall visual function and quality of life.

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