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For opticians and optometrists

When the right glasses bring no relief

We will say it right at the start: there are no robust data for a coupling between bite position and visual function. What does exist concerns pain – and you see that regularly.

You know these patients

Persistent headaches, eye pressure, “strenuous” vision or neck and shoulder tension despite a correctly determined and well-fitted correction. Frequent changes of glasses without relief.

The connection

What has been measured

  1. 01Measured / described

    Referred pain from the masticatory muscles

    The myofascial trigger point is defined by four criteria; for the temporalis muscle , the peri- and retro-orbital region is part of the typical referral pattern. This explains pressure behind the eye with a flawless correction.

  2. 02Measured / described

    Head posture and jaw are connected – in both directions

    The association between malocclusion class and head posture has been measured at 1.3 to 2.9 degrees ; the anatomical pathway via the supra- and infrahyoid muscles, platysma and neck extensors is undisputed. A conspicuous head or gaze posture is therefore a finding that concerns both sides.

  3. 03Where the evidence ends

    Where the evidence ends

    For refraction, accommodation and convergence there is no proven connection with bite position. Anyone who tells you otherwise has no source for it. Our statement concerns only pain and muscle tension – and there too as an association.

Indication

When a referral is worthwhile

First, and without exception: red flags and unclear findings belong in specialist work-up, before any functional diagnostics. The CMD perspective complements, it does not replace.

Worthwhile

  • Persistent asthenopic complaints or tension-type headaches despite correct correction
  • Additional jaw, neck or posture signs
  • When the ophthalmological work-up is complete and unremarkable

Not worthwhile

  • Before refraction and ophthalmological work-up are complete
  • With the expectation that a splint replaces or changes the correction

Your patient remains yours.

After the assessment or after regulation is complete, we always refer back to you. We only provide further treatment at your explicit written request.

The same applies the other way round: in all our questionnaires, every vision and eye topic includes the question about glasses and contact lenses – so that we do not attribute to the jaw a headache that comes from uncorrected refractive error.

Next steps

Three routes – your choice

  • 01

    I want to know more

    The full-text sources, our measurement protocols and the clinical explanatory model with its level of evidence disclosed.

    Request documents
  • 02

    I have a question about a case

    Call-back from the CMD specialist, not from reception.

    Ask a question
  • 03

    I would like to refer

    By phone, email or letter – whatever suits you. The findings report comes back to you.

    Referral

Other specialties

To the overview