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Dissociated Vertical Divergence

Fig. 1 Left eye drifting upward gehind neurtal density filter.

What is DVD?

DVD is a condition in which one eye drifts upward. The eye may drift upward only occasionally or be deviated almost constantly. The amount of drifting may even vary during the course of the day. Often, DVD is only seen in one eye by a parent, while testing by an ophthalmologist may reveal the problem is actually present in both eyes [See figure 1].

When and why does DVD occur?

DVD is usually manifest by 2-3 years of age. Occurrence is highest in those with early onset strabismus (misalignment of the eyes). DVD is highly correlated with poor fusion (decreased eye teaming). Children who undergo eye muscle surgery early in life, particularly for esotropia, may develop DVD years later. Children with good fusion have less chance of developing DVD.

What treatment options are there for DVD?

Glasses, eye patching or eye drops can sometimes reduce the frequency of the DVD. Eye muscle surgery is usually indicated when the DVD is large and/or frequently present. Regardless of treatment, DVD is often present to some extent. The goal of treatment is to minimize the frequency and the size of the DVD.

What does someone with DVD see when their eye drifts up?

Blurred or double vision is usually not noticed when the eye drifts upward. The visual system suppresses or blocks the vision in the eye that drifts upward.

Does DVD affect visual acuity?

DVD can affect vision. Since the image from the upward deviated eye is suppressed or blocked, decreased visual acuity amblyopia may occur in a child. Amblyopia is treated with glasses, eye patching, or eye drops. If amblyopia is not treated in early childhood, the decreased vision can be permanent.

Do eye exercises help DVD?

Eye exercises do not help DVD.