Dissociated Vertical Divergence

Abstract

Background: Dissociated vertical divergence (DVD) has been attributed to a human dorsal light reflex that emerges when single binocular vision is precluded in infancy. If this is the case, then DVD should be associated with a subjective sensation of tilt.Methods: Prospective examination of 9 patients with DVD and 9 control subjects to determine whether monocular occlusion and alternate occlusion induces a subjective sensation of visual tilt or body tilt.Results: Alternate occlusion disclosed a tilt in the subjective visual vertical in 8 of the 9 patients with DVD and in none of 9 control subjects. On occlusion of the fixating eye, a vertical pencil positioned in the sagittal plane was perceived as instantaneously tilted, with its upper pole tipped toward the side of the covered eye. This visual tilt was quickly followed by a perceived rotation back to vertical, which coincided with the dorsally directed drift of the covered eye. Conclusion:In patients with DVD, monocular occlusion is associated with a subjective visual tilt that is annulled by a cyclovertical divergence movement of the eyes. This observation supports the notion that DVD is a human dorsal light reflex, which functions to restore vertical visual orientation when unequal binocular visual input evokes a subjective sensation of visual tilt.

Concussed patients with visually induced dizziness exhibit increased ocular torsion and vertical vergence during optokinetic gaze-stabilization

“…From a neurophysiological perspective, it has previously been put forward that dissociated vertical divergence (DVD), a condition seen in children who due to amblyopia express vertical divergence and a perceptual tilt of the viewed scene, is an expression of an otherwise vestigial dorsal light reflex 45 , 46 . Considering the reliance on vestibular input towards the dorsal light reflex 47 , and the association of vestibular signalling as a cause for vertical vergence 21 , we put forward that the current study supports the notion that visually induced vertical divergence may reflect an optokinetic activation of the vestibular system 25 .…”

Concussed patients with visually induced dizziness exhibit increased ocular torsion and vertical vergence during optokinetic gaze-stabilization

“…From a neurophysiological perspective, it has previously been put forward that dissociated vertical divergence (DVD), a condition seen in children who due to amblyopia express vertical divergence and a perceptual tilt of the viewed scene, is an expression of an otherwise vestigial dorsal light reflex 45 , 46 . Considering the reliance on vestibular input towards the dorsal light reflex 47 , and the association of vestibular signalling as a cause for vertical vergence 21 , we put forward that the current study supports the notion that visually induced vertical divergence may reflect an optokinetic activation of the vestibular system 25 .…”

Optokinetic stimulation induces vertical vergence, possibly through a non-visual pathway

“…From an alternative perspective, vertical vergence has been suggested to have an even deeper connection to visual cues related to gravitational and vestibular information: The dorsal light reflex aims to provide visual cues for postural control, indicating the position of the sun, and have been shown to potentiate vestibular signals in early vertebrates, indicating a significant visuovestibular interaction 25 . A human correlate to this reflex have been suggested in patients with dissociated vertical vergence (DVD), a condition in which the eyes are pathologically skewed during monocular occlusion 26,27 . Theoretically, this could manifest as visually induced vertical vergence brought on by varying levels of luminosity reaching each eye.…”

Interventions for dissociated vertical deviation

“…Some investigators believe it is due to a vestigial righting reflex (Brodsky 1999; Brodsky 2002; Brodsky 2011), whereas others feel it is a nystagmus blocking mechanism (Guyton 1998; Guyton 2000; Guyton 2004). Other authors have suggested that DVD is the result of unbalanced cortical input to subcortical pathways (ten Tusscher 2010).…”

Concussed patients with visually induced dizziness exhibit increased ocular torsion and vertical vergence during optokinetic gaze-stabilization

“…From a neurophysiological perspective, it has previously been put forward that dissociated vertical divergence (DVD), a condition seen in children who due to amblyopia express vertical divergence and a perceptual tilt of the viewed scene, is an expression of an otherwise vestigial dorsal light reflex 45 , 46 . Considering the reliance on vestibular input towards the dorsal light reflex 47 , and the association of vestibular signalling as a cause for vertical vergence 21 , we put forward that the current study supports the notion that visually induced vertical divergence may reflect an optokinetic activation of the vestibular system 25 .…”

Optokinetic stimulation induces vertical vergence, possibly through a non-visual pathway

“…From an alternative perspective, vertical vergence has been suggested to have an even deeper connection to visual cues related to gravitational and vestibular information: The dorsal light reflex aims to provide visual cues for postural control, indicating the position of the sun, and have been shown to potentiate vestibular signals in early vertebrates, indicating a significant visuovestibular interaction 25 . A human correlate to this reflex have been suggested in patients with dissociated vertical vergence (DVD), a condition in which the eyes are pathologically skewed during monocular occlusion 26,27 . Theoretically, this could manifest as visually induced vertical vergence brought on by varying levels of luminosity reaching each eye.…”

Interventions for dissociated vertical deviation

“…Some investigators believe it is due to a vestigial righting reflex (Brodsky 1999; Brodsky 2002; Brodsky 2011), whereas others feel it is a nystagmus blocking mechanism (Guyton 1998; Guyton 2000; Guyton 2004). Other authors have suggested that DVD is the result of unbalanced cortical input to subcortical pathways (ten Tusscher 2010).…”

Concussed patients with visually induced dizziness exhibit increased ocular torsion and vertical vergence during optokinetic gaze-stabilization

“…From a neurophysiological perspective, it has previously been put forward that dissociated vertical divergence (DVD), a condition seen in children who due to amblyopia express vertical divergence and a perceptual tilt of the viewed scene, is an expression of an otherwise vestigial dorsal light reflex 45 , 46 . Considering the reliance on vestibular input towards the dorsal light reflex 47 , and the association of vestibular signalling as a cause for vertical vergence 21 , we put forward that the current study supports the notion that visually induced vertical divergence may reflect an optokinetic activation of the vestibular system 25 .…”

Optokinetic stimulation induces vertical vergence, possibly through a non-visual pathway

“…From an alternative perspective, vertical vergence has been suggested to have an even deeper connection to visual cues related to gravitational and vestibular information: The dorsal light reflex aims to provide visual cues for postural control, indicating the position of the sun, and have been shown to potentiate vestibular signals in early vertebrates, indicating a significant visuovestibular interaction 25 . A human correlate to this reflex have been suggested in patients with dissociated vertical vergence (DVD), a condition in which the eyes are pathologically skewed during monocular occlusion 26,27 . Theoretically, this could manifest as visually induced vertical vergence brought on by varying levels of luminosity reaching each eye.…”

Interventions for dissociated vertical deviation

“…Some investigators believe it is due to a vestigial righting reflex (Brodsky 1999; Brodsky 2002; Brodsky 2011), whereas others feel it is a nystagmus blocking mechanism (Guyton 1998; Guyton 2000; Guyton 2004). Other authors have suggested that DVD is the result of unbalanced cortical input to subcortical pathways (ten Tusscher 2010).…”