Vision Specialists
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Vision Specialists

Binocular Vision Dysfunction and anxiety while driving

How a vision misalignment could explain your stress behind the wheel

For most of us, driving is a mundane activity that blurs together with the rest of our day. The average American drives more than 13,000 miles every year, crisscrossing roads to their home, work, and loved ones.

However, some people experience a great deal of anxiety on the road. Specific triggers include merging on the highway, driving at high speeds, and seeing past glare. These otherwise common activities can be nerve-wracking for some, causing them pull over or quit driving altogether.

Anxiety can have many different causes. A history of car accidents or being a new driver are common reasons for stress behind the wheel. Others suffer from a more general form of anxiety that can be triggered by driving a car.

The visual demands involved with driving can be enough to trigger anxiety for people with Binocular Vision Dysfunction (BVD). Driving requires us to track moving targets with precision, estimate distance using our depth perception, and be attentive to multiple objects in our field of view. When our eyes are unable to work together, these activities become significantly more challenging and high stress can be the result.

In addition to binocular vision, our vestibular system — the series of fluid-filled canals in the inner ear that help us maintain balance and coordination — is put on high-duty when we deal with the bumps, turns, and acceleration involved with driving. Put together, these two systems are crucial for our ability to respond to the environment and drive safely.

Driving confidently requires a careful and coordinated balance between the visual and vestibular systems.

Considering the visual and orientational changes involved with driving, it’s no wonder that any dysfunction of the eyes or ears can cause problems. Let’s look at one patient in particular who suffered from considerable dizziness and anxiety on the road and benefited greatly from a binocular vision exam.

Steve is a lawyer working for a firm in Cincinnati, Ohio. A few years ago, Steve started suffering from severe bouts of anxiety when driving on his way to work, especially in traffic and high-speed situations. At night, when conditions made it even harder to see other cars, Steve’s anxiety reached its height.

Like many of our patients, Steve even resorted to avoiding the highway altogether, becoming intimately familiar with the side roads that led to his destinations. Over the years, Steve also started to notice that his dizziness occurred off the road, affecting his walking and overall coordination.

Steve was deeply distressed by these symptoms, feeling a pronounced lack of control over his life. For a while he remained a quiet suffer, thinking that his symptoms were merely psychological.

Steve had no idea that his anxiety on the road was caused by a visual problem involving his eye muscles.

After a Google search of his symptoms, Steve found an online questionnaire (link)… From there, he found his way to our neurovisual optometry office where a comprehensive binocular vision exam was performed. Steve’s measurements were consistent with a vision misalignment, indicating that his eye muscles were straining in order to give him a clear image of the world.

This struggle to maintain visual clarity was also conflicting with Steve’s vestibular system, contributing to his feelings of dizziness on the road and general imbalance.

Prism is typically added to a patient’s eyeglass prescription

Steve finally found relief through prismatic correction of his Binocular Vision Dysfunction. Prism is a type of lens that shifts the direction of light, correcting for imbalances between the muscles in the two eyes. Wearing his new glasses, Steve could finally drive confidently and was no longer paralyzed by anxiety on the highway.

What caused Steve’s vision misalignment in the first place? Binocular Vision Dysfunction can be congenital. But in Steve’s case, it’s likely that the vision misalignment was caused by a car accident in the 1980s. His symptoms may have only started when his eye muscles were finally unable to compensate for the imbalance, causing pronounced stress and dizziness under the high demands of driving.

Either way, Steve’s story speaks to the importance of getting a binocular vision exam performed. A neurovisual specialist’s intervention can be the key to alleviating stress behind the wheel.

Turn a fish’s tail, and its eyes will adjust automatically to this change in body position. As unlikely as it sounds, the neural circuits that account for this are present in our own anatomy: we have interneurons that connect our oculomotor (eye-moving) nerves with our vestibular nerves.

The vestibular-ocular reflex is one demonstration of this connection. You can observe this reflex yourself by focusing on a certain object and turning your head in multiple directions while staying focused on it. Your ability to keep your eyes fixed on the object — called gaze stabilization — is due to a highly delicate coordination between your inner ears and your eye muscles.

Our visual system has evolved to keep track of head and body movements

When the balance between the visual and vestibular systems is thrown off, we can easily become dizzy and uncoordinated. In a disorder known as visual vertigo, patients report dizziness and unsteadiness triggered by certain visual stimuli.

There is well-documented medical literature relating symptoms of visual vertigo with significant anxiety, not only on the road but also when in large spaces, grocery shopping, and under fluorescent lighting. It’s no surprise that patients should feel anxiety under these conditions. How would you react if common stimuli were enough to cause you dizziness at a moment’s notice?

Visual vertigo can be pronounced in patients with Binocular Vision Dysfunction. When a vision misalignment is present, visual and vestibular stimuli conflict with each other, causing a mismatch that contributes to feelings of dizziness and unease.

Driving, particularly on the highway, puts the balance between these two systems to the test. The eyes need to be finely-tuned in order to deal with both visual and vestibular stimuli.

Because of the connection between sight and balance, a comprehensive binocular vision exam should be considered in cases of anxiety and dizziness while driving.

A Binocular Vision Dysfunction is rarely the first choice when diagnosing dizziness. But when all other options have been ruled out, a comprehensive binocular vision exam can be an important step in getting to the bottom of your symptoms. For our patients who suffer from anxiety, prism glasses can mean the difference between fear on the road and driving confidently.

To find an optometrist that specializes in binocular vision, check out the Vision Specialists website at




Reflections on the delivery of care at Vision Specialists of Michigan, written by a scribe.

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Farid Alsabeh

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