For those of you who suffer from headaches, problems with balance, motion sickness, or poor depth perception – read on. This blog is for you.  We're going to discuss Vertical Heterophoria (VH), which can be especially frustrating because it can go undiagnosed for many years. That's because symptoms of VH overlap and mimic a number of other conditions. Patients with Vertical Heterophoria usually receive treatment for vertigo, migraines, psychogenic dizziness, anxiety and panic disorders, atypical Meniere's, as well as other conditions. Treatment can range from pain medications to vestiblular therapy – which if often ineffective. That's because the root of the problem (Vertical Heterophoria) continues untreated.

Vertical Heterophoria knows no boundaries. It can affect both children and adults, males or females, and causes can be congenital, a brain injury (TBI, concussion, stroke, etc), or illness.

Symptoms of Vertical Heterophoria (VH) vary from person to person. One person may suffer from one or two symptoms while another may experience a combination of multiple symptoms. Symptoms also vary in severity ranging from bothersome to incapacitating.This further complicates and postpones an accurate diagnosis.

Symptoms of Vertical Heterophoria can include:

  • Blurred vision • Carsickness
  • Difficulty concentrating
  • Disorientation
  • Dizziness
  • Double vision
  • Head tilt
  • Headaches or migraines
  • Problems with depth perception
  • Seeing “movement” in peripheral vision
  • Sensitivity to bright lights and glare
  • Vertigo


How common is Vertical Heterophoria (VH)? Unfortunately, more common than you may think. An estimate of the prevalence of VH is 20% of the population. The good news is that with proper diagnosis and treatment it is possible to reduce or completely eliminate symptoms.

Vertical Heterophoria (VH) is a type of binocular vision disorder that results from eye muscle strain caused by a misalignment of the eyes in the vertical direction. This means that the eyes cannot work together properly in this specific direction – vertically. Even individuals with what is considered a minor vertical misalignment can experience symptoms significant enough to impact daily activities.

Individuals with Vertical Heterophoria (VH):

  • Are more susceptible to falling. VH can disrupt the vestibular system and the sense of balance
  • More likely to experience a “dizzy spell” when driving. Navigating around a corner in the road or seeing cars speed by on the highway can cause dizziness. Individuals with VH describe the sensation that they feel as if the car if moving backward when they know their foot is on the brake. This can lead to added stress, extreme anxiety and even debilitating panic attacks at the thought of driving.
  • Commonly suffer from motion sickness (carsickness, sea sickness). These symptoms can increase in severity when riding in the car as a passenger or in the back seat.
  • Have a history of headaches or painful migraines. This is one of the most painful symptoms of Vertical Heterophoria. Headaches can last from several minutes to several hours, and can be as frequent as daily in the most severe cases. Patients can describe the pain as located in the back of the head, behind the eyes or sinuses, in the forehead, or temples.
  • Describe words as “jumping” on the page. Because of the vertical misalignment of the eyes images in the visual field appear to “jump” or “move” on the page. This symptom can increase in severity and frequency as an individual reads or works on the computer for increased periods of time. For some people they may notice this symptom after reading for only a few minutes while others may notice words “moving” after a more extended period of time or towards the end of the school or work day.


We are often asked why Vertical Heterophoria isn't diagnosed more often? This is a condition that is diagnosed by eye doctors, and most eye doctors do not receive training in Vertical Heterophoria – meaning they aren't trained to identify VH and lack the equipment needed to perform the specialized testing necessary to diagnose Vertical Heterophoria. Keep in mind that most eye doctors perform routine eye exams with the goal to fit contact lenses or prescribe eyeglasses and to test for common eye conditions like cataracts, glaucoma or macular degeneration and do not provide the specialized care you receive with a neurooptometrist.

If you suspect Vertical Heterophoria (VH), or would like to rule it out as a possible diagnosis, it is important that you have a neuro-optometric evaluation with a residency trained neurooptometrist. We are fortunate to have Dr. Ryan C. Johnson, OD FAAO serving patients in Boise, Idaho and the surrounding area. Dr. Johnson completed his residency in neurooptometry at University of California Berkeley. He has the specialized training and clinical expertise to accurately diagnose and treat Vertical Heterophoria (VH). Why wait? We can help.

Posted by lyndajohnson at 2/1/2023 9:32:00 PM
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