Published Academic Articles


Published Academic Articles

Vertical Heterophoria Treatment Ameliorates Headache, Dizziness and Anxiety


Background: Vertical heterophoria is known to cause headache, dizziness, and anxiety, three commonly comorbid diseases. Earlier studies have shown that correction of vertical heterophoria smaller than the standard error of existing phoria tests can reduce symptoms. This study is designed to demonstrate the effectiveness of prism lenses correcting for small amounts of vertical heterophoria in reducing symptoms in patients presenting with headache, vestibular, and/or anxiety symptoms, and also demonstrates the effectiveness of micro-prism lenses to diagnose vertical heterophoria.

Methods: Retrospective study of patients diagnosed with vertical heterophoria who responded to treatment with micro-prism lenses and completed survey instruments at an optometry clinic in Michigan, USA. This study included 111 patients presenting with vertical heterophoria symptoms between 07/2009 and 06/2011 who self-reported significant disability from headache, dizziness, and/or anxiety on the Headache Disability Inventory, Dizziness Handicap Inventory, and Zung Self-Rating Anxiety Scale respectively, and completed pre- and posttreatment survey instruments. Participants were treated by application of corrective micro-prism lenses (vertical prism 0.25D-2.50D) followed by 1-3 lens prescription adjustments over 8-12 weeks. Outcomes were measured by repeating survey instruments.

Results: Mean HDI score reduced from 37.55 to 22.13, effect size d = .54. Mean DHI score reduced from 38.01 to 18.68, effect size d = .72. Mean SAS score reduced from 42.13 to 34.22, effect size d = .80. No side effects reported.

Conclusions: Screening and treatment for vertical heterophoria using micro-prism lenses provided significant symptom relief for patients with headache, dizziness, and anxiety symptoms that had not responded to traditional treatments.

Keywords: anxiety, binocular vision dysfunction, dizziness, headache, micro-prism, vertical heterophoria


Treatment with micro-prism lenses (the amount and direction determined by using the Prism Challenge technique) markedly reduces symptoms of headache, dizziness, and anxiety in patients diagnosed with vertical heterophoria. The effectiveness of this treatment approach highlights the need for further prospective and multi-center studies as well as the need for a deeper mechanistic understanding of the pathophysiology of VH. The need for further study notwithstanding, the minimal risks and cost-effectiveness of this therapeutic approach should make screening for and treating VH a consideration for patients with headaches, dizziness, and anxiety. This would be particularly true for those patients who have experienced less-than-desirable outcomes with standard treatment modalities.

Published in:

Optometry & Visual Performance | Volume 8 | Issue 1 | 2020, March

Read the full research paper with figures (PDF)

Authors: Debby L. Feinberg, Mark S. Rosner, Arthur J. Rosner

Published in: Optometry & Visual Performance | Volume 8 | Issue 1 | 2020, March

Poster presentation at: The Anxiety Disorders of America Annual Meeting, Arlington, VA, April 2012

Poster presentation at: The American Headache Society 54th Annual Scientific Meeting, Los Angeles, CA, June 2012

Poster presentation at: The American Academy of Otolaryngology – Head and Neck Surgeons Annual Meeting, September 2012

Posted in: Otology and Neurotology, January 2020

Authors: Debby L. Feinberg, OD, Mark S. Rosner, MD, Arthur J. Rosner, MD

Published in:Future Science | 2022 | FSO813

Authors: Cherylea J Browne, Paul Fahey, Stella R Sheeba, Margie H Sharpe, Mark Rosner, Debby Feinberg & Viviana Mucci

Published in:PM&R | Volume 2, 244-253, April 2010

Authors: Jennifer E. Doble, MD, Debby L. Feinberg, OD, Mark S. Rosner, MD, Arthur J. Rosner, MD

Published in: Optometry & Visual Performance | Volume 8 | Issue 1 | 2020, March

Authors: Debby L. Feinberg, Mark S. Rosner, Arthur J. Rosner

Posted presentation at: The American Academy of Optometry Annual meeting, November 10, 2016

Authors: Debby L. Feinberg, Mark S. Rosner, Arthur J. Rosner

Posted online:February 1, 2020, Vestibular Disorders Association (VEDA).

Authors: Debby L. Feinberg, Mark S. Rosner

Poster presentation at: The 9th World Congress on Brain Injury, Edinburgh, Scotland March 2012

Poster presentation at: The Anxiety Disorders of America Annual Meeting, Arlington, VA, April 2012

Authors: Mark S. Rosner, Debby L. Feinberg, Jennifer E. Doble & Arthur J. Rosner

Published in: The journal Brain Injury, February 2016.

Authors: Debby L. Feinberg, Mark S. Rosner

Published online: November 2, 2016, Vestibular Disorders Association (VEDA).

Watch these videos of BVD patient experiences:

Daria's Binocular Vision Story

Robin's Traumatic Brain Injury

Veteran's Story of Binocular Vision Dysfunction and Triumph over TBI

It may be your eyes

It may be your eyes

  • American Academy Optometry
  • American Optometric Association
  • Michigan Optometric Association
  • VEDA
  • Neuro Optometry Rehabilitation Association

Dr. Sandy DiPonio earned her optometry degree from Illinois College of Optometry in 1996. She is a highly skilled and experienced eye care professional dedicated to giving her patients of all ages excellent and compassionate care. She has a wide variety of experience in binocular vision, pediatric and adult eye care, ocular disease and contact lens fitting. She strives to provide each of her patients the best quality of life they can achieve with their vision through knowledge and education of treatment options.

Dr. DiPonio is a member of the American Optometric Society and Michigan Optometric Society.

Dr. Sally Hoey has been practicing optometry since graduating from Michigan College of Optometry in 2001. During her time in optometry school, she developed an interest in binocular vision, culminating in a senior thesis involving binocular vision.

Prior to joining Vision Specialists of Michigan, Dr. Hoey specialized in the diagnosis and treatment of vision-related learning problems as well as other binocular vision disorders. Her other areas of interest include specialty contact lens fittings and treating dry eye. Dr. Hoey strives to provide her patients with clear, comfortable vision while meeting their individual needs at the same time.

Dr. Hoey had the opportunity to provide eye care on an optometric mission trip to Guyana, South America and vision screenings at a local medical clinic. She is a member of the American Optometric Association, Michigan Optometric Association, Metropolitan Detroit Optometric Society and the College of Optometrists in Vision Development.

Dr. Jennifer Place graduated with honors from Michigan College of Optometry in 2001.

Before joining Vision Specialists of Michigan, she specialized in treating pediatric and adult patients with binocular vision disorders and vision-related learning problems, as well as fitting specialty contact lenses and managing various types of ocular disease. She enjoys working with patients with unique visual needs, and she takes great pride in providing all patients with highly customized care.

Dr. Place has volunteered for Opening Eyes, a program that provides eye exams to the athletes of the Michigan Special Olympics, and she participated in an international mission to St. Lucia to provide eye care to those in need. Dr. Place is a member of the Detroit Optometric Society, the Michigan Optometric Association, the American Optometric Association, the College of Vision Development, and the Optometric Extension Program Foundation.

Dr. Mary Jo Ference has been practicing optometry since 1990 upon graduating from Ferris State University- Michigan College of Optometry, and is certified in Low Vision Rehabilitation. She has worked at Sinai-Grace Hospital systems for over 20 years before joining Vision Specialists of Michigan in 2013 to work with binocular vision disorders. Her clinical areas of expertise include visual rehabilitation of pediatric and adult patients who have suffered from brain trauma, injury or disease. She has taught both optometry and ophthalmology residents at Sinai Grace Hospital. Dr. Ference has sat on numerous boards, including Sinai Grace Hospital, Berry Out-Patient Surgical Center, and Seedlings Braille Books for the Blind. She is actively involved in area school districts to provide education, training and access for students, teachers, OT’s and PT’s to eye care service rehabilitation information. Dr. Ference has lectured extensively nationally and internationally.

Dr. Debby Feinberg began practicing Optometry in Oakland County in 1983, upon graduating from Illinois College of Optometry. She joined her father, Dr. Paul C. Feinberg, at Mall Optical Center, which was located in Summit Place Mall.

Since 1995 Dr. Feinberg has been developing the field of NeuroVisual Medicine which is the optometric subspecialty that identifies and treats neurological / medical symptoms that originate directly or indirectly in the visual system.

Dr. Feinberg has been performing pioneering work with Binocular Vision Dysfunction (BVD), a condition where a vision misalignment (frequently subtle) creates difficulties with the two eyes working together to create a single 3-dimensional image, and difficulties with the two eyes following that image as it moves.

The symptoms caused by BVD are not usually associated with problems with the visual system, and include headache, dizziness, anxiety and panic, persistent post-concussive symptoms, gait instability and balance problems, frequent falls, neck pain, motion sickness, nausea, and reading and learning problems.

In 2004. Dr. Feinberg established Vision Specialists of Birmingham, specifically designing the practice to accommodate the needs of the NeuroVisual Medicine patient.

In 2011, the office moved to its current location in Bloomfield Hills and updated its name to Vision Specialists of Michigan.