An Alumna Shares Her Vision Quest

January 18, 2022

By the time she enrolled for a master’s degree at Columbia Mailman School in the early 1990s, Denise Drace-Brownell (MPH ’93) was already a successful legal and public affairs executive specializing in environmental law and policy. While pursuing her master’s in the Department of Environmental Health Sciences, she wrote a paper on climate change with a prescient perspective on the health risks of a warming planet. Last year, she announced a bequest to the School’s Program in Climate and Health to train the next generation on the work she began years earlier.

Since her time at Columbia Mailman, Drace-Brownell has also made significant contributions to the field of binocular vision disorder. Binocular vision disorder occurs when the two eyes are not working together as a team. Eyes can normally focus comfortably for continuous periods at distance or up close (accommodation), and form one single image (vergence). For people with binocular vision disorders, these activities can be challenging.

Her own binocular vision issue was resolved in 2009 through a standard prescription of prism glasses by a New York City optometrist. While it was transformative for her to be finally free from blurred vision, she wondered why it had taken so many years before this long-accepted pair of glasses had been prescribed. Moreover, she wondered how many others were out there, like her, without an adequate resolution. She vowed to find out.

The impact of binocular vision disorder on individuals can be devastating—ranging from severe learning difficulties to decreased function leading to job loss to deficiency in everyday activities. Slow reading, challenges with reading comprehension, fatigue, and balance issues are among the major symptoms. Drace-Brownell found that the visual processes of reading abstract formulas are different from reading words.

Drace-Brownell identified the prevalence of the disorder at over 12 percent of the population in developed countries, with some studies showing it to be greater than 30 percent. These numbers can be expected to increase from society’s expanded use of digital devices.

With an eye to advance treatment options, she improved upon current prism technology and developed eyewear that is easier to use.

She discovered that optometrists—who do 85 percent of eye testing—want to be trained more in the process and procedure of prescribing prisms. She found that the U.S. military already recognizes the severity of the problem, requiring that a binocular vision exam be performed on all applicants to its military academies as well as ROTC cadets.

While the exact origins of binocular vision disorder remain unknown, other risk factors include family history, head trauma, neurological disorders, facial asymmetry, diabetes, and aging, though the disorder can affect people at any age. Today’s increased use of computers and digital devices is adding to the vision symptoms in people with the disorder.

“Patients often do not tell an eye doctor about their eye fatigue problems because previous doctors have told them there is nothing wrong with their eyes,” says Drace-Brownell. “We need to educate patients and the public regarding this issue so that they will discuss this with their doctors. We need to update testing protocols to reflect how we spend most of our time these days—with computers and digital devices. The transition to a digital future demands improvements in vision diagnostics, treatments, and technologies.”

In 2020 she wrote Binocular Vision Disorder: A Patient’s Guide to a Life-Limiting, Often Underdiagnosed, Medical Condition. Published by Eliva Press, the book is available free as a digital download on and through Amazon. “I recognized there was confusion with jargon among patients and among many eyecare professionals, and that there needed to be clear explanations regarding useful diagnostic and treatment options,” she says. “I’m excited to bring this information to the millions who need this help. This is one public health issue we can resolve.”

This article was adapted with permission from an article previously published in Eyes on Eyecare