Dizziness, nausea and vertigo can be debilitating symptoms that many people just learn to live with. But what if they didn’t have to? Most often we think of dizziness as a vestibular problem, because we are all familiar with how our inner ear is important for balance, and it is. Many cases of dizziness are caused by problems such as benign paroxysmal positional vertigo (BPPV). This happens when the crystals in the inner ear are out of place, and the signals the brain receives from the inner ear are completely out of whack with what’s really going on. BPPV can be tested for with the Dix-Hallpike test and treated very quickly and effectively. If a persons dizziness or vertigo doesn’t respond, many professionals assume it’s a central vestibular problem. Or is it?
What’s often overlooked is the role that vision plays in our understanding of where we are in space. The reason a person gets sea-sick on a boat, isn’t because of the vestibular input, it’s because of a mis-match between the visual and vestibular inputs. I can also put goggles on you that will cause the same effect. If the way the brain is processing vision isn’t accurate, then it can cause similar problems. But wait you say, ‘wouldn’t that be picked up on eye testing? I’ve seen the optometrist, ophthalmologist, and neuro-ophthalmologist who all say that my eyes are healthy and fine.’ Too often this is is the case. The eyes are physically healthy, and can see clearly, but most often there is no testing into how the eyes are actually working together, and how that information is being processed. The physical health and acuity has been checked, but what about the function?
It’s also common that it’s chalked up to Meniere’s disease or similar conditions. I’m yet to see a case of Meniere’s where vision isn’t also part of the problem. The wonderful part about this area of work, is that vision either is, or isn’t part of the problem. It’s actually quite easy to identify and test objectively. For a subjective self screener, click this link. If the picture bothers you, that means that visual stimulus isn’t being processed well, and it’s provoking symptoms. It shouldn’t. If it does, it’s treatable.
Too often I’m seeing people who have been suffering for years and years. Just a few weeks ago I met a man for whom the world moved and wasn’t stable for the last 15 plus years (oscillopsia). It impacted his work and social life. The other day I had a follow up with a wonderful young professional woman, who had to give up a huge amount of her prestigious career because nobody could figure out why she was always dizzy, had trouble with computer screens and would often get nauseas from visual stimulation. Now she’s back to work, and her story is tear jerker.
In both of those cases I was able to prescribe glasses in a way that changed the perception of depth and space to improve the visual and vestibular interaction. The world stood still. Literally. It didn’t move. Dizziness stopped. For many people it can take months of vision therapy and work, but often it needs to start with a prescription that is for more than just clarity. There is a great letter from an incredible nurse here: https://neurovisualperformance.ca/testimonial-vision-therapy-improves-vertigo-recovery/
The science behind it is simple. Imagine if you were a golfer and you always put short. If I put glasses on you that made you think the whole was further away (perhaps a more accurate perception of reality), then you would be able to better coordinate what you’re doing. We change the input, for a more desire-able output. Then we do vision therapy to actually re-train how your brain is processing and calculating that information as well. To get really nerdy and complex, the visual-vestibular interaction has to do with something called VOR gain. It’s the relationship between vestibular (inner ear) input, and the response of the eyes to that movement. If that relationship is off, we can also uses glasses to help improve that. That’s often the trick to improving dizziness, nausea, or oscillopsia right away.
So if you, or someone you love is suffering with dizziness, nausea, veritigo or oscillopsia, please make sure that they have an in depth examination by an optometrist who really understands vision therapy and visual-vestibular function. The most important thing we have in our life is time, and it’s a shame to have it impacted by something that’s been overlooked.