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Validation of the Binocular Vision Dysfunction Questionnaire (BVDQ)

Validation of the Binocular Vision Dysfunction Questionnaire (BVDQ)

OBJECTIVE

Among patients presenting with dizziness, visual dysfunction must be considered, including vertical heterophoria (VH), a frequently under-identified form of binocular vision dysfunction where there is vertical discrepancy between the lines of sight of the eyes when at physiologic rest. Current self-rated screening measures do not account for complex VH symptomatology including dizziness/ambulation difficulties, nausea, headache, anxiety, neck pain, and reading impairment. VH must be differentiated from vestibular/otolithic etiologies, as their treatment frequently provides inadequate relief, yet treatment of the VH can reduce/eliminate symptoms. The objective of this study is to create a valid measurement tool (binocular vision dysfunction questionnaire) to assist in identifying VH among dizzy patients to aid in appropriate referral.

Study Design: Retrospective case series.

Setting: Tertiary referral center.

Patients: One hundred twenty-six patients presenting to an optometric binocular vision subspecialist diagnosed with VH.

Intervention: Psychometric study. The measurement tool’s internal consistency and test–retest reliability was assessed.

DISCUSSION

When a concussion occurs, diffuse damage is done to the brain. Any part of the brain can be injured, which is why there are so many different types of symptoms associated with concussions. One part of the brain that is frequently injured is the visual system, resulting in Binocular Vision Dysfunction (BVD), where the two eyes have difficulty working smoothly together as a team due to a slight misalignment. While this misalignment can be very subtle, it can make it incredibly difficult for our eyes to send one clear image to our brain.
Here’s what happens when someone has BVD: With two eyes, we are able to see one clear image. This is because our brain is able to transform the images seen by each eye into a single image, which is known as binocular vision.

In patients with BVD, there is a slight misalignment between their eyes resulting in their eyes being out of sync with one another, causing the brain to have a very difficult time processing those two separate images to form one clear image.

The result? The brain forces the eye aligning muscles to fix the problem by realigning the eyes. But the realignment is only temporary and misalignment then recurs, which is followed closely by realignment, and the cycle of misalignment and realignment continues. Over time, this places an immense amount of strain on the eye muscles and leads to dizziness and difficulty reading, as well as a variety of other symptoms.

Read the full research paper with figures (PDF)

Watch these videos of BVD patient experiences:

https://youtu.be/M-OOeuG3OJg
https://www.youtube.com/watch?v=xhXpzftxrNg
https://www.youtube.com/watch?v=mY1zo4RHhjs

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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.