The See-Sick Syndrome…when visual dysfunction causes motion sickness


Recently I had the pleasure of presenting a  CE lecture to primary care ODs about a vision related problem that receives little attention from the media yet plagues the quality of life of millions of people. It affects children and adults with an increase in symptoms in adults.  But,  those who suffer from the condition rarely associate it to their vision and don’t think to mention it to their primary care eye doctor. Indeed for most of these patients, whether adults or children,  the malady they suffer is assumed to be just  “their nature”.  So unless detected and properly treated, the individual with this condition is forced to cope with the problem…a problem that is just sickening. Yes,  the symptom that is fundamental to these patients is “motion sickness”.  You know, that “yucky” feeling that almost all of us have experienced at one time or another. But in these individuals the  malaise of motion sickness is a frequent, annoying (and can be severe) response to activities that are generally quite benign to the majority of people, such as:

  • Riding in a car or a plane and trying to read
  • Peripheral visual shadows or movement such as a rotating ceiling fan or the shadows of trees when driving down a country road or even looking at a striped shirt
  • Rapid eye movement such as watching sporting event or viewing an action movie on a big screen
  • Watching a 3-D movie

    Dr. Fortenbacher lectures on See-Sick Syndrome

  • Walking down the aisle of a grocery store
  • Walking within a crowd of people

The name of this condition that results in easy and frequent motion sickness is the Neuro-Ocular Vestibular Dysfunction (NOVD) or the See-Sick Syndrome (SSS).

To understand how motion sickness is related to visual dysfunction, one must look at the neurology of the brain that deals with providing stability and normalcy to our lives.  The part of the brain that allows us to have a sense of balance and calm even when the visual space world from our eyes plus the movement of our body, influenced by the forces of gravity and objects within our environment is called the Vestibular System. Just as the eyes are the sensory receptors for vision, within the middle ear are the “peripheral sensory receptors” including the semi circular canals (SCC) and the otolyth organs (utricle and saccule) which responds to our body’s vertical, horizontal and rotational movements.

The beauty of the vestibular system goes beyond the sensory receptor within the middle ear. The beauty is the central processing within the variety of other sensory systems within the brain that provides normalcy to our world so that we know up from down, our sense of  where we are in space and which way we are going.  One way to think about it is that the vestibular system is the neural software that helps us to keep us from “getting lost in space”.

Yes the vestibular system is closely integrated with tactile (touch), proprioception (sense of movement), auditory (hearing), kinesthesia (muscle awareness) and vision. Indeed in order for us to have a sense of balance and stability the “neural software” of the vestibular system must effectively integrate with of these sensory  systems and especially the dominant sensory system -VISION!

The problem with visual-vestibular integration typically begins in these patients with an associated binocular (eye teaming), accommodative (eye focussing), oculomotor (visual tracking) and/or visual perceptual problem. The visual condition alone may not be severe enough to result in overt visual symptoms but just enough to provide interference for the patient in their visual-vestibular connection. As a result they become symptomatic with the activities that have a visually stimulating central and peripheral vision component. Examples of reading while riding in a moving car, watching an action movie or especially 3-D movie on a big screen, moving through a big supermarket with attention on details but processing peripherally all the displayed items simultaneously. All are examples of how a fragile visual function coupled with ineffective integration with the “neural-normalcy software” (vestibular system) results in the classic motion sickness symptoms for the patient even though they are not engaged in anything that would cause a problem to most people.

The good news for patients diagnosed with the See-Sick Syndrome is that there is an effective treatment solution. This usually involves a combination of properly prescribed ophthalmic lenses as well as office-based optometric vision therapy along with some home-oriented activities. The duration of treatment is dependent on a variety of factors but when the patient is consistent with their prescribed doctor supervised treatment plan it routinely takes less than 3 months. The end result is problem solved and the patient can enjoy life without coping strategies; a life long resolution of the condition and no more easy motion sickness!

For more in-depth information click on the icon below and you can download my Powerpoint presentation. Also I would like to give a special thanks to Dr. Michelle Brennan who helped in the development of my lecture.

Dan L. Fortenbacher, O.,D, FCOVD

17 thoughts on “The See-Sick Syndrome…when visual dysfunction causes motion sickness

  1. My motion sickness always involves motion: windy roads, sailing over waves, and that amusement park ride called “the scrambler” OR a movie of any of the above without the accompanying motion, which is actually more severe. It must be the disconnect of seeing the movement without feeling it, which throws me out of kilter every time.

  2. Can anyone tell me if this SSS works? I had a head injury a few years ago and have been struggling with these symptoms everysince. I’ve tried all the doctors here in Dallas. I’m wondering whether it’s worth flying to MI. If it would work I would fly anywhere!!!! Thank you so much! Melissa from Dallas

    • Kristina,
      To find a doctor who can help, go to http://www.covd.org and click on “Locate a Doctor”. Look for a doctor who is a Fellow, which means they have completed their Board Certification in vision therapy. An Associate may also be able to help if they have experience with this condition. Once you find someone close to you through the http://www.covd.org doctor locator, I would encourage you to call their office and ask if they have experience treating this condition. Better yet, ask if the doctor would speak to you so you can discuss your own personal situation.

  3. My 10 yr old daughter has epilepsy (complex partial). She is currently seizure free and medication free but has recently suffered from “see-sickness”. It is progressively getting worse, to the point that she seldom even leaves the house. Dr. Fortenbacher, where do I begin in helping her overcome this battle? Thanks for your help and time.

    • Carrie,
      Thank you for your comment and question. It is important for you to find a doctor who works with Neuro-ocular vestibular dysfunction, “See-Sick Syndrome”. I would encourage you to go to http://www.covd.org and click on the doctor locator to find a doctor nearest you. Then call their office and ask if the the doctor is experienced with this condition and also if they provide office-based optometric vision therapy.

  4. I get the symptoms of SSS (very severely) but only when wearing prescription glasses (reading or distance) for a relatively short amount of time (typing this is no fun), watching 3D or fast cut movie scenes or being stupid enough to go on a roller coaster. Getting around without glasses causes no problems except for the above. All of what I read here and in other vestibular disorder sites relate to my experiences except for the glasses as the trigger. Any ideas?

    • Yes, your experience of having your ophthalmic glasses trigger SSS symptoms is a classic example of your visual system unable to tolerate a visual spatial change. When you put on corrective lenses, depending on the correction, there is going to be a change in the size and location of optical image. Normally, when there is good visual-vestibular integration, your visual system can handle the size and space change that occurs when you put on your glasses with no problem. However, individuals with SSS have very low tolerance to spatial changes and therefore often become symptomatic.

  5. my daughter suffered a concussion in April. she has done physical and vestibular therapy which has helped her balance and headaches. However she still gets dizzy when she reads or concentrates in school. Is this something that can help her ?

  6. Hi Dan, it’s fantastic that you are able to provide this resource and information — it’s hard to find much info about the See-Sick Syndrome (there isn’t even a Wikipedia article for it!).

    My girlfriend has self-diagnosed with a severe case of SSS. It is also worth noting that she has a condition known as Postural Orthostatic Tachycardia Syndrome (POTS) on top of Neuro Ocular-Vestibular Dysfunction. She can’t even drive a block before feeling the overbearing symptoms that SSS patients experience. We’ve bought a Marsden ball and plan on doing self-therapy at home since she can’t even get to a specialist without feeling a sickness that she wouldn’t wish on her worst enemy.

    We’d love if we could get a specialist to her place — but finding one who will perform in-home therapy, let alone therapy for SSS is something we have not yet found. Her quality of life is so terrible. Do you have any recommendations for resources to help with in-home therapy using the Marsden ball? I’ve read success rates are lower without supervised care, but we don’t really have any options at this point :(

    • Thank you for your comment Chris. The best advise is to first have your girl friend see a doctor who is experienced in the field of neuro optometry and does the proper diagnostic testing. There are a multitude of variables that influence the treatment plan. So, suggesting that there are specific home remedies for a condition based solely on some of the symptoms that you describe would be irresponsible of me. The best thing is to find a doctor through either http://www.covd.org or http://www.nora.cc and have him or her work with you in any capacity that you can. If your difficulty seems to center on her just getting out to the doctor to provide the office-based treatment, some offices are providing home-based support with Skype. Here is an example of it in our office.

      I hope this was helpful.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s