Dissociated Vertical Divergence
Perceptual Correlates of the Human Dorsal Light Reflex
Michael C. Brodsky, MD
Arch Ophthalmol. 2002;120:1174-1178.
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.
From the Departments of Ophthalmology and Pediatrics, University of
Arkansas for Medical Sciences, Little Rock.
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