I suspect that for many of you, as it was for me, this year’s annual COVD meeting was the first of its kind in which you participated. As I commented in the chat online at its conclusion, “CONNECT-ED” was an incredibly well-organized and rewarding experience given the circumstances. There is certainly a learning curve to such meetings and, at first, it can be a dizzying experience to navigate. Which brings me to the topic of dizziness, of which vertigo is the most common type. As reviewed in this recent article in Frontiers in Neurology, vertigo is rooted in the interactions of the visual and vestibular systems. Yet it is the vestibular system that seems to garner most of the headlines (no pun intended) in the medical field.
That is one reason why the following article in Medical Hypotheses, Visual vertigo: Vertigo of oculomotor origin, is so intriguing. Perhaps “intriguing” doesn’t do it justice.
The first two paragraphs in the Discussion section are mind-blowing, given that the source of the article is not a behavioral or developmental/rehabilitation optometric journal. In fact the author of the article, Seong Chin, M.D., is a geriatrician with several offices in Illinois who is on staff at Lutheran General Hospital in Park Ridge. Have a look at the Discussion section, and see what you think:
I had the pleasure kicking off this year’s COVD meeting and Continuing Education offerings by introducing Dr. Debby Feinberg, a colleague in Michigan who attributes great significance to small amounts of uncompensated vertical heterophoria, including dizziness. In fact, 6 of the 25 questions on the newly validated BVDQ (Binocular Vision Dysfunction Questionnaire) in the journal Otology & Neurotology involve dizziness directly.
The title of Dr. Feinberg’s VDR presentation was A Neurovisual Approach to Binocular Vision Dysfunction Featuring Vertical Prism. She presented a slide about the interaction between vertical and horizontal alignments and fine tuning that caught my eye after having read Dr. Chin’s paper in Medical Hypotheses. As you read his section on “Superior Rectus Muscle and Convergence Insufficiency”, consider what he says about CNIII innervation to the SR and MR, and the effects of sympathetic activation. It dovetails nicely with Dr. Feinberg’s theories, and the pervasive performance problems and symptomology in some patients when these systems are in conflict or are disrupted, rather than synergistic.