Evaluation of treatment response and symptom progression in 400 patients with visual snow syndrome.

Puledda, Francesca; Vandenbussche, Nicolas; Moreno-Ajona, David; Eren, Ozan; Schankin, Christoph Josef; Goadsby, Peter J (2022). Evaluation of treatment response and symptom progression in 400 patients with visual snow syndrome. The British journal of ophthalmology, 106(9), pp. 1318-1324. BMJ Publishing Group 10.1136/bjophthalmol-2020-318653

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AIMS

To gather information on useful medications to treat visual snow syndrome (VSS) as well as to validate an instrument to assess its clinical severity and the course of the disorder over time.

METHODS

Four hundred patients with VSS were included in this web-based prospective questionnaire study. All subjects completed a treatment questionnaire and a clinical diary. The first allowed evaluation of the effects of previous medications on visual snow, while the second measured VSS symptoms daily over the course of 30 days.

RESULTS

Patients commonly reported previous use of medications such as antidepressants, antiepileptics, antibiotics and benzodiazepines. However, none of these drug classes was beneficial for the majority of patients. Recreational drugs and alcohol worsened visual snow symptoms in several reports. Vitamins and benzodiazepines had high therapeutic ratios, although in most cases they did not change the course of VSS.The monthly diary confirmed that the static in VSS is a consistent symptom over time. It also showed that indoor and fluorescent lights have a worse effect on symptoms when compared with natural outdoor lighting.

CONCLUSIONS

The study confirms clinical experience that medications are generally ineffective in VSS, with the exception of vitamins and perhaps benzodiazepines, which could be beneficial in some patients. The 30-day diary represents a useful tool to measure symptom progression over time, which could be used in future trials on VSS.

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