Vertical heterophoria is a funny name, so I get it, but no, I’m not making it up. There are (by my exaggerated estimate) roughly a million comorbid conditions that are related to ADHD from restless leg syndrome, to sleep apnea, now to this eye condition. I think vertical heterophoria is my favorite of all the comorbid conditions. Why? Because it has the most interesting sounding name, and it was the most easily corrected for me. Living with ADHD is complicated stuff. We don’t need any more to manage.
Vertical Heterophoria? Now you’re just making stuff up.
I never would have imagined in a million years that my ADHD could be related to anything that involved my eyes. Strap in guys, you’re going to learn all about what vertical heterophoria is, what causes vertical heterophoria, how it is related to ADHD, and what to do if you suspect that YOU have something wrong with your eyes.
What is vertical heterophoria, you ask?
It is an eye condition that is caused by the misalignment of the eyes. Vertical heterophoria is what’s known as a binocular vision dysfunction. That means there is a slight imperceptible difference in your eyesight that could be causing you an array of unpleasant symptoms. Your eyes are designed to work together to create one clear image to present to your brain. When there is dysfunction there, your eye muscles work overtime to help correct the misalignment with the images. People who have vertical heterophoria can experience increasingly debilitating symptoms as their eye muscles work overtime to compensate for the visual disturbances that vertical heterophoria can cause. Some of those symptoms can include motion sickness, anxiety, vertigo, neck pain, and more.
This video explains binocular vision dysfunction quick and painlessly
What causes vertical heterophoria?
Like most conditions, it can be difficult to narrow down exactly what causes vertical heterophoria. You could have been born with it. Symptoms tend not to appear until later in life after the eye muscles have been stained over a period of time. There is also the possibility of a traumatic brain injury, a stroke, or a neurological disorder having contributed to vertical heterophoria. All of these instances can affect the way that the eye muscles function and then you have the same scenario.
Is Vertical Heterophoria ADHD related?
It is closely related to ADHD. According to the Neurovisual Center of New York, “Up to 50% of children with ADHD have a vision problem which contributes to reading and learning difficulties. Often, the vision problem is an eye misalignment so small that it’s missed on routine vision exams.” That means if you are living with ADHD you could be experiencing the symptoms of vertical heterophoria and not even know it. The fact that vertical heterophoria is not widely known amongst a community with such a high risk for developing it is something that we should work to change. It wasn’t until several years after my ADHD diagnosis that I learned about vertical heterophoria, and it was completely by accident.
What was my experience with vertical heterophoria?
I have been an eyeglass wearer for most of my life. I can remember the teachers, assuming it would help me pay attention in class more and stop the constant headaches I seemed to have, suggested that I go for an eye exam. That was about 4th grade, and they discovered that I have astigmatism which was no surprise as several people in my family have it. Life continued on, I grew up, and never gave another thought to my eyesight because glasses did everything I needed them to do.
Discovering Vertical Heterophoria was a stroke of luck.
I’d love to tell you that I spent hours circling the internet looking for answers because it is a way more interesting story, but the fact of the matter is that isn’t how it happened. Vertical heterophoria is something I discovered completely by chance. I learned about vertical heterophoria on an episode of the See in ADHD podcast. In that episode, I learned that the disorder is something that cannot be detected in the average eye exam.
I also learned that the disorder is an ADHD comorbid. At the time, I was living with chronic neck pain, constant dizziness, and a headache that never seemed to go away. I was frequently nauseous and anxious. The doctor had prescribed various painkillers, muscle relaxers, and even a custom mixed prescription pain cream to help me manage the constant neck pain. Some days I couldn’t even go to work because the pain was so bad. When I heard that episode, I began to recognize myself in the symptoms described.
My binocular vision exam
When I showed up for my eye exam, I was very nervous. Regardless, my symptoms were awful and I needed to see if I could find answers. We went through the normal eye exam that I am used to, and from there we proceeded to the portions of the exam that were specific to vertical heterophoria.
One of the exams that stands out to me still was when the doctor had me walk down a hallway. I started in the center and by the end of the hallway, I was completely off to the side, though I intended to walk in a straight line. It was a bizarre experience. By the end of the exam, I had a pair of test glasses where I could sit and stare out the window waiting for my eyes to adjust. As they did, I could feel the anxiety lessen and my neck pain began to fade away. Once I got my glasses I was living in a new pain-free world. The one thing I DO miss is the ability to wear contacts. Unfortunately, prisms don’t come in contact lenses, but maybe one day they’ll figure it out.
What are the signs and symptoms of vertical heterophoria?
The symptoms of vertical heterophoria can be quite debilitating. They definitely interrupted my daily life. The pain I dealt with on a daily basis was so excruciating that I missed days of work and lost wages because of the constant headaches, dizziness, and nausea.
“Symptoms of vertical heterophoria include not only migraines and severe headaches, but dizziness, nausea, anxiety, neck pain and balance issues. Situations where you may experience the VH symptoms include:
- Moving your head from side to side (dizziness)
- Standing up straight after bending over (dizziness)
- Standing up from a sitting position (dizziness)
- Riding in the passenger seat of a vehicle (dizziness and anxiety)
- Rounding curves while in the car (dizziness and anxiety)
- Driving on the freeway (anxiety and panic)
These symptoms are also similar to those endured by individuals suffering from an inner ear disorder, Meniere’s disease or MS. With so many possibilities, it’s essential that you take an assessment to determine if your eyes are indeed the problem. Regular eye doctors won’t be able to pick up VH during a routine eye exam, which is why you need the expertise of a NeuroVisual professional.” (Source: Vision Specialists of Michigan)
Why hasn’t this shown up on your eye exam?
As I mentioned before, I have been an eyeglass wearer since I was a young child. Why didn’t I know about vertical heterophoria sooner? Part of the reason is pretty simple: I wasn’t symptomatic enough yet. I had headaches and things, but those were attributed to the fact that I stared at screens frequently and I read a lot, etc. It is always easy to explain things away when we aren’t suffering enough to do something about it.
The other reason is just as important for the rest of you to know. This eye condition is not part of the routine eye exam. Vertical heterophoria is a condition that requires special equipment to test, and it also requires special training to diagnose it that the majority of eye doctors don’t have. In other words, your 24-hour eyeglass place isn’t going to catch vertical heterophoria because they aren’t looking for it.
Treatment for vertical heterophoria
You’re probably wondering what it would take to correct an issue like vertical heterophoria. Do you have to take medicine? Are there surgeries in your future? Will you need to see a specialist frequently? Don’t worry at all. The solution to vertical heterophoria is simple: your doctor adds a set of prisms to your eyeglasses that correct the vision issue.
Do I have vertical heterophoria?
I remember how I felt when I first heard about vertical heterophoria. It was like somebody had handed me a gift that I hadn’t even known I needed. I wasn’t sure if I had it, but all of the symptoms were so familiar to me. The chronic pain I experienced on a daily basis was awful. It was frustrating and I was losing hope. Hearing about this random eye condition made me feel hopeful that I could get out of the chronic pain cycle and off all of the pain medication once and for all.
If you see yourself in these symptoms and you’d like to know more, never fear. There is an online test that you can take to determine if you need to see a doctor to talk about vertical heterophoria. When I took my online test, within a day or so a friendly receptionist from the doctor’s office I still go to today rang me up and got me scheduled for an exam. The exam was scheduled, I got my glasses, and the rest is history. If only I could resolve every problem this easily.
Vertical Heterophoria Resources
There is a wealth of knowledge on the internet. You’re going to need some more resources to tap into the wealth of knowledge about vertical heterophoria. I’ve got a few great resources for you if you just gotta know more.
Online Test For Vertical Heterophoria– take this online quiz to see if your eyes could be causing the problem.
Vertical Heterophoria Exposed – on this episode of See in ADHD, Jennie Friedman and I discuss the disorder and you can hear the actual audio recording of my eye exam and the huge reaction I had.
Why Other Doctors Can’t Test For Vertical Heterophoria– one of the common questions people have about Vertical Heterophoria is “why doesn’t this show up on my eye exam?” Here’s your answer.
Dr. Cheryl Berger-Israeloff explains Vertical Heterophoria
This is the woman who saved me from the pain. Dr. Cheryl Berger-Israeloff was the guest on the podcast where I first learned about Vertical Heterophoria. Her thoroughness and her passion really helped me to understand. It made me want to seek some answers for myself about vertical heterophoria.
Driving issues with Vertical Heterophoria explained
I’ve heard from so many people who have had driving issues they think could be vertical heterophoria related. This is an amazing testimonial from a lady who dealt with driving issues. This story is absolutely amazing
Vertical Heterophoria and Migraines
This young lady was a migraine sufferer. Like me, she had lost hope. The doctor finally told her that he couldn’t do anything but pray for her. She too happened upon knowledge of this condition by chance. This is such a powerful testimonial.
I have a binocular vision disorder
Hopefully, you’re not suffering from pain and nausea and headaches, but if you do, there may be hope for you. Take the test, and talk to a doctor about your eyes. Learning about this condition and getting treatment for it gave me my life back. In fact, this diagnosis was equally as life-changing as my ADHD diagnosis was. When I sat with those glasses on my face and felt the pain melting out of my neck, I started to weep because I knew I finally had an answer. I hope you find an answer too.
Until next time,
René
For more ADHD resources, please visit CHADD (children and adults with ADD)
What else is on Black Girl, Lost Keys?
Women Deal with ADHD Differently
I’m not sure http://www.nvcofny.com will “reach out to me” as I live overseas. Still, it is something to bring to my GP and optometrist. Goodness knows I would say I have weird eyes now; one is nearsighted and one is farsighted.
Definitely take it to them, Nora! Taking care of my Vertical Heterophoria has been life changing
Hi Nora, this is Dr. Marissa from the Neuro Visual Of New York. Please fill out the questionnaire on our website and either myself or Dr. Cheryl will be able to e-mail you back. Unfortunately, most optometrists are not trained to diagnose and treat vertical heterophoria.
Hi Dr. Marissa! Thank you so much for reading and reaching out. I would absolutely love to interview you for a subsequent article if you’d be interested.
Hi Rene,
That would be great. I would love to do that!
Wonderful, Dr. Marissa! How would you like me to get in touch?
Hi Rene,
Sorry that I never saw your reply. You can reach me at drmarissa@nvcofny.com
I look forward to hearing from you!
Hi! I’m Ashley and I work with Dr. Debby Feinberg at Vision Specialists of Michigan and the NeuroVisual Medicine Institute that trains optometrists on how to find and treat VH. We would love to speak with you! You can reach me at ashley@nvminstitute.org. Thank you!
Hello Ashley! I will absolutely be in touch
René, I’m Aspie curious… Are you ever aware of the parts of the world lurking outside the frames of your glasses? Maybe just as blurry movement that predicts when something may pop into view as you turn your head, or follows objects after you turn away from them? Most people I ask swear they never see anything outside their lenses, but I’m compulsively and often painfully aware of what is happening there.
Trying to fit that part of the world to the glasses forced on me as a young child warped my sense of space and my body in ways most people never feel without LSD. And left traces of the “adaptations” in parts of my body and brain neuroscience is just beginning to explore. I can’t help suspecting this happens to many people who wear glasses – but the visual effects stay in their subconscious, only the effects on movement and balance get noticed.
If the single prism adjustment to central vision works for you, I don’t want to trigger new complications. But I’m curious how long you’ve worn glasses, what kinds (+, -, astig, ?), and why? Did you wear them full time, or only for certain activities? Did you ever wear contacts or take breaks from lenses? When did you first notice the stress that the prism correction fixes, and what did you think it was about?
Hey there! I have worn glasses since I was 8 or so because I couldn’t see the board. I also have a astigmatism. At first I only wore them to see the board, these days I wear glasses from dusk till dawn. I have worn contacts, I do not wear them now because there is no way to do prisms in contact lenses. As for stress, I have a stress problem anyway so I attributed it to the many many things that stress me out, lol.
My first lenses were at 9 years, but they had the now discredited “Plus Lens Theory” bifocal adds – sort of like prism areas within the rest of the lens. Worn every waking moment.
Sounds like you wear your prisms all day now, but only wore glasses or contacts when you really needed them before. And you didn’t relate your stress to vision until you discovered the prism option?
So do you “live” entirely inside the prism-adjusted world now? Do you ever notice the unadjusted world outside the frames?
I was born with a lazy eye, that by 7 years old my brain got tired of, so it shut down the visuals from the optical nerve. My left eye is now effectively blind, with only shadows and colours that it can see, and that’s only if I focus on it really hard. So I basically just use my right eye, and it doesn’t really affect me too badly except my depth perception is extremely poor and I have a “If you can see this I can’t see you.” notice for my desk for people coming up on the left.
This is very interesting!
Brains make so many adjustments for us, isn’t it fascinating?
my daughter with adhd has a hard time reading. Could this condition maybe be what reading is so hard for her? How do you find the right eye dr to test for this?She is now 19& has never been given glasses.
Hey, there is a link to a questionnaire in the article, if you take the questionnaire a doctor will reach out.
re: the test you mention at https://www.nvcofny.com/patients/bvd-questionnaire/ , I question the motives and trustworthyness of any organization that demands contact information prior to any kind of information on the internet.
Perfectly alright. In that case, don’t take the test.
The night before getting my “field test” at the opthamologist. He refused to measure each eye for alignment, insisting that an advancing cataract has been my sole problem. This is my second visit. I have written the eye doctor a two-page letter refuting his easy-out answer of a cataract blame. I’ve faced anxiety over driving and stairs, facing dizziness regularly. He has your blog post, too. (My gift!) I’m writing to thank you for that magnificent post that first opened my eyes. Plus, I hoped a note to you would bring good luck!
I wish you had a more receptive ophthalmologist.
This is common for us.
Cataracts can be corrected but this has to be done via prescription.
I saw my optometrist for this. My friend came too and discovered she had it. My optometrist is so cool that way.
They said if you feel dizzy when you stand up after sitting (caused by the blood pressure needing to change when you change positions) that it an ADHD thing and it’s because of your eyes.. but it happens to almost everyone and it’s blood pressure, not eyes… and if you get car sick that is your ADHD eyes? what? It sounds like scoliosis for your eyes… a way for charlatans to get money out of you
If you get dizzy frequently maybe your blood pressure is too low? are you on a salt-free fad diet? I’d talk to an MD first… saying that getting dizzy in a situation where almost everyone gets dizzy is a sign you need to give them money is a massive massive red flag.
Google exists, so you don’t have to call people charlatans without confirming. Here’s a basic Google Scholar search that would have revealed the very answers you were looking for:
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C36&q=vertical+heterophoria&oq=
Here’s one with JUST dizziness as related to vertical heterophoria. I trust you can investigate the rest on your own: https://scholar.google.com/scholar?hl=en&as_sdt=0,36&qsp=11&q=vertical+heterophoria+dizziness&qst=bb
How long did it take you to adjust to the prism glasses and how long before you got symptom relief? I just got a pair of Neurolens and it’s been a week and I feel like my symptoms are worse.
Hi, I would definitely recommend reaching out to your doctor about worsening symptoms as everyone’s body is different.
Immediate relief. Putting that corrected lens my eye Doc uses to test eyes felt like a burden had been lifted. It was the same for my friend.
I put a call into my eye doctor today. Really hoping they know about this condition and I don’t have to battle my anxiety and adhd trying to find someone in the area that does test for it and takes my insurance. Nightmare!