It may be your eyes:
Vertical Heterophoria Treatment Ameliorates Headache, Dizziness and Anxiety

Vertical Heterophoria Treatment Ameliorates Headache, Dizziness and Anxiety


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)
Read the full research paper with figures (PDF)

It may be your eyes

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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.