A couple of years ago I blogged about the pilgrimage that Orthodox Jewish patients were making to special practitioners and practices, as far away as England, for what they perceived to be “special prisms”. I was and remain somewhat ambivalent about these practices. On the one hand they raise awareness of the role of binocular function that is too often overlooked. On the other hand they do nothing to dispel, and in some instances foster the notion that only Dr. X deals with prism. Or that the prism lenses can only be made through special laboratories.
My ambivalence about the prism pilgrimage now extends to prism for vertical heterophoria. A practitioner in Michigan is doing a wonderful job of creating awareness about symptomatic, uncompensated vertical phoria. You can read the back story about Dr. Debby Feinberg in the Detroit Jewish News and Crain’s Detroit.
I bought a copy of her book which is interesting, and comprised largely of patient testimonials. There is an extensive preview of it available online.
Dr. Feinberg has appendices in the book with separate adult and pediatric vertical heterophoria symptom questionnaires. They are useful, and a Likert Scale accompanies items similar in nature to the CISS but incorporating signs and symptoms specific to uncompensated vertical such as head tilt, neck pain, dizziness, and nausea. Dr. Feinberg makes it clear that she is not the first one to note that uncompensated vertical heterophoria (VH) can cause significant binocular discomfort, but claims to be the first one successfully treating with prisms. In a review of the literature she found that an ophthalmologist, Stevens, first identified it in 1887; an optometrist, Roy, wrote about in in the 1950s and 60s; and two ophthalmic textbook giants, Borish and Duke-Elder wrote about it, but with little consequence. In her words, it appears that their “discovery” of VH is really a “re-discovery”. As an aside, I was somewhat surprised that Dr. Feinberg omits mention of other sources addressing vertical phoria, the most obvious one coming to mind is Bruce Wick’s seminal chapter 20 years ago: Prescribing Prism for Patients With Vertical Heterophoria in Susan Cotter’s book Clinical Uses of Prism.
Dr. Feinberg describes herself as a Neurovisual Optometrist, and now offers a NeuroVisual Optometry Training Program. So is there something here that is unique and proprietary? You be the judge …