Three Questions Patients Wish You’d Ask
By Matt Rosner
- 4 min read
Lately, we’ve been thinking about questions. Not the “which-is-better-one-or-two” kind, but the questions that actually reveal how your patients live, read, work, and navigate their world. The quiet ones that uncover the clues of subtle phorias long before a cover test ever will.
Because here’s something we’ve learned across thousands of NeuroVisual Evaluations: the more we ask, the more we see. And when you ask the right questions, patients often tell you everything you need to know without realizing they’re doing it.
The Clues Hiding in Plain Sight
Some questions seem so simple they feel optional. They’re not. They’re doorways into a patient’s visual experience, and they almost always reveal more than expected.
One of our favorites is, “Have you ever had a concussion or bumped your head… even years ago?”
Patients answer this as if they’re reciting ancient history. But phorias don’t care about timelines. A head injury from college soccer or a fender bender in 2019 can still have consequences that show up today as headaches, motion sickness, or difficulty focusing.
Another one: “Have you noticed difficulties with reading?”
Not “Can you read?” but "Do you lose your place when reading?”
People with subtle misalignment rarely tell you that reading is hard. They just avoid it. They say they’re tired, or “not really a reader.” It’s a quiet symptom hiding in plain sight.
And then there’s the secret weapon: “Can you text or read in the car as a passenger?”
Most people assume motion sickness is universal. It’s not. Difficulty reading in the car is an incredibly reliable indicator that something deeper is off with binocular stability, often vertical.
There’s also the unsaid question, the one you can answer with your eyes: “Do they have a head tilt?”
Patients don’t notice their own tilt. But you can when you sit directly across from the patient. And it’s often the most honest piece of data in the room.
What All These Clues Have in Common
Across every practice we work with, from boutique private offices to large multi-doctor networks, the same pattern emerges. These small signals show up again and again in patients with subtle vertical and horizontal phorias.
The patients rarely come in saying, “I have a binocular vision disorder (BVD).”
They come in sharing these almost insignificant details in their case history:
- “I’m dizzy sometimes.”
- “Screens make me tired.”
- “I can’t read in the car.”
- “My headaches are random.”
- “I feel off, but I can’t explain it.”
These aren’t “red flag” symptoms. They’re breadcrumb symptoms, signs of misalignment that only become obvious when you know what to look for.
Meet the Culprit: Binocular Vision Dysfunction (BVD)
All those tiny breadcrumbs? They point to something real: Binocular Vision Dysfunction (BVD). It’s a subtle misalignment in the way the eyes work together, so small that it’s often missed, but big enough to make a person’s world feel a little off. The tricky part? Most patients don’t realize these symptoms are connected to their vision, or that BVD could be the cause.
And here’s the wild part: about 1 in 5 people are walking around with the symptoms of BVD. And most of them have been quietly struggling for years.
Here are the dots that patients can’t connect on their own: head tilts, car-texting nausea, and random dizziness. They notice the pieces, but you’re the one who can put the puzzle together. Spotting these signs, asking a few key questions, and framing these symptoms through the lens of BVD is often the first time patients understand what’s been happening all along.
The clues are there. Now it’s just a matter of knowing where to start and which questions to ask.
A Simple Way to Start Screening Today
If you want an easy entry point (something you can add without reworking your entire exam) start with three simple questions:
- Do you get nauseous when reading or texting in the car?
- Do big stores like Walmart ever feel visually overwhelming?
- Do you lose your place, re-read lines, or feel like the words move when you read
- (Optional) Do you avoid busy roads or night driving because it just feels… off?
Then look for two silent clues:
Head tilt: Notice which side they lean toward—and how consistently.
Gait: Have them walk down the hallway. Do they move straight and confidently, or subtly veer?
Ask these three questions, notice these two patterns, and suddenly you’re seeing something most clinicians never catch.
If noticing these clues sparks something in you, just know this: you don’t have to figure it out alone. There are straightforward ways to build this into your care without reinventing your exam.
There’s a whole community of clinicians who’ve leaned into this work, using simple, well-tested tools and clear clinical processes to make treating BVD feel intuitive, not intimidating.
A Final Thought
Once you start seeing these patterns, it’s hard to go back. Patients who once felt “complicated” suddenly make sense. Symptoms that used to feel disconnected become part of a clear story.
And that leaves you with a choice.
You can keep recognizing these patients and refer them out—which still helps enormously.
Or you can step into treating them yourself, expanding both your scope and your impact.
Both paths serve the patient.
Only one opens a new lane for your practice.
If you’re curious what that could look like, let’s talk.
About NVMI
The NeuroVisual Medicine Institute (NVMI) equips optometrists with the tools, training, and support to deliver life-changing care for patients with Binocular Vision Dysfunction (BVD). Through education, mentorship, and a national network of specialists, NVMI helps practices expand access to NeuroVisual Medicine and build thriving, purpose-driven teams.
Book a consultation to see if a NeuroVisual Specialty is right for your practice.