I am not a student of fine art and although I appreciate the talent involved in being an artist, I never developed appreciation for much of anything that adorns the walls of the world’s museums of fine art. That may change someday. Who knows?
But the topic of this post really has little to do with art, or at least not the art of painting. Pablo Picasso painted this picture to the left and what got my attention was the exaggerated placement of her eyes, one higher than the other. My google search of Picasso’s works reveal multiple paintings of women, most of whom have one eye set noticeably higher than the other. Photos of Picasso seemed to reveal that he had one eye higher than the other also, but that’s hard to tell based on a snapshot.
And that leads me to my latest obsession with my patients, so to speak, which is the frequent diagnosis of what’s called a vertical heterophoria. The lady in the painting has it and so far two of my patients this morning have it. I’ve sat on this topic for a couple of months because I wanted to compare the similarities between the patients that have this condition before reporting on it. So here goes…
As I’ve written about in earlier posts, vision is complicated. The front of the eye has to focus light directly on to the retina in the back of the eye just like the movie projector has to focus it’s light directly on to the movie screen. If the light is focused too far in front or behind that screen (retina), the image will be out of focus. But just as important for clear vision, is the eyes’ ability to work in unison and aim on a level plain with each other (binocular vision). If the eyes are not in sync, visual acuity can get worse.
I will admit that in my earlier years of practice, I simply didn’t understand the importance of binocular vision. We had classes on the subject in optometry school, but I recall that they were, well…boring beyond belief. None of my clinic instructors emphasized the importance during my early patient encounters, and so I learned how to go through an eye exam without worrying too much about how well the eyes worked together. Then after graduating, I went to work in a busy practice and often skipped that evaluation altogether giving what I thought were thorough eye exams. But I had just oversimplified the complicated nature of vision and, for the most part, made most all of my patients happy.
But every now and then, I think back to some of the patients in which I never really could figure out why I couldn’t get them to see a little better. And now I think I know why…they had a problem with their binocular vision and very likely a vertical heterophoria.
************So here’s where it gets good and hopefully you’re still with me. Here’s the typical patient scenario of a patient who I diagnose with a vertical heterophoria:
Most of these patients complain of eye strain and headaches, especially related to near activities. They may call them migraines and they may often be light sensitive both indoors and outdoors.
Most of these patients have a history of motion sickness or at least admit to difficulty reading in a moving vehicle and most likely they hate riding in the back seat of a moving vehicle.
Most of these patients have developed some sort of compensating head tilt towards the left or right shoulder. I believe this tilt is used to level out their visual world just like we’d see the bubble move on the level when trying to hang a picture straight on a wall.
Most of these patients admit to a history of neck and more likely shoulder pain on only one side (left or right). They are no stranger to chiropractors or massage therapists. Older patients additionally have lower back pain that has worsened over the years.
Many younger patients have been diagnosed with reading or attention deficit difficulties. I’ve seen patients with this condition under 10 years old who already see a chiropractor regularly. Are you kidding me???
Some of these patients become very uncomfortable in places crowded with lots of people.
Many have been diagnosed with fibromyalgia or chronic fatigue syndrome. They have tried all sorts of ways to manage their pain, yet nothing has really helped. Since looking closer at this vertical deviation, I have yet to see a patient with either of the diagnoses that did not have a vertical heterophoria.
These patients tend to be grumpier and just look worn out. Technicians and staff may dislike dealing with them because of this, even if they’ve been with the practice for years.
I’ve seen a couple of patients with a history of scoliosis who were diagnosed. Is there a connection? One study I found seems to think so.
Six members of the staff have it. My wife has it. And I have a mild one also. And I suspect my mother-in-law has it too. She HATES riding in the backseats of cars, especially in the mountains of Lake Tahoe when I’m driving. But that’s another story…
So I don’t know if I’m on to something big or on to nothing at all. But there are some incredible similarities amongst these patients. I’ve said it before, every decision we make in our life is based not on what we see, but how we see the world. If our world is not level, the brain tends to dislike that and will find a way to compensate. Why not a head tilt? Do it all your life and why wouldn’t your neck or shoulders start to feel the effects of it? Why wouldn’t that translate down to your back?
***(Edit: Forgot to include this section in original post) So I try to help them by prescribing prism oriented vertically, either base up or base down. I do quite a bit of trial framing in the exam room in order to make sure the patients can handle this new part of their prescription. Usually it’s only as small as 0.50 diopters, so I only prescribe it in to one lens. If it’s a higher amount, I will balance it between both lenses. Usually, they will be back shortly with family members to tell me how they’re doing. After just two months of doing this and losing count of how many times I’ve done it, I’ve only had to remove the prism once (talk about jinxing myself). Two people have told me they haven’t had a single headache since then. At this point, I don’t schedule them back for follow up visits but I’m thinking about changing that.
I’ve contacted some local chiropractors back in Keene and their interest is lukewarm at best. I’m hoping I can sit down with one soon to see if any of this makes sense to them based on their training. I would love to team up with one or all of them to help people with pain, if possible.
So that takes me back to Picasso. Did he deal with this problem himself? I couldn’t find that he had any reported history of any of the conditions I listed above. But it was thought that Vincent van Gogh’s Starry Night was possibly painted that way because he was near-sighted. If anyone knows more about Picasso, please let me know.
In the meantime, check out this website: www.vsofm.com. This is an eye doctor in Michigan who has made a living helping patients with this condition. She has a ton of great information that helped me look further in to this.
Thank you for reading and please contact me with any questions.
- Lots of info at the VS OP website (eyeworks.com)
- When Doctors and Patients Talk. (psychologytoday.com)
- Can people with strabismus develop other vision problems? (zocdoc.com)
- Why 3D Movies Could Be So Much More (blogs.forbes.com)