VISUAL SNOW UPDATE: 2018 - John C Hagan III, MD, FACS, FAAO's Blog

I will have cataract surgery soon. Before surgery, I am using contact lenses to try out the best combination for monovision (one eye for distance, one eye for reading). My current eye glasses is -500/-500. My optometrist let me try out -500/-250 first. I may read newspaper, but then I felt eye strain after a while. Then I tried -500/-225, I felt a little dizzy. Maybe the 2.75 diopter difference is over my tolerant limit. Now, I am trying -425/-200. It seems to work OK. No blurry, no dizziness. But cataract makes my both eyes a little foggy. It's hard for me to tell. I can read fine print, but still need a little effort. I don't know after surgery, I will read easily and clearly with -200. My priority is getting off the reading glasses completely. I love reading. I would love to read easily without glasses and without eye strain. I don't mind to wear glasses when I drive if I need. Does anyone have experience to have clear vision on reading with -200 on one eye and near 0 on the other eye after surgery? For cataract surgery, should I choose -400/-150 instead, just to be sure I can read easily? Or -425/200 should be fine? My tolerance difference between two eyes is 2.5 diopters. I appreciate any doctor's opinion or any other patients' sharing experience.

This is not the right place to post this question. Copy it and post it in a new question on the eye forum. It is a common question and has been discussed before. You can also read other discussions. This relates to visual snow here.
John C. Hagan III, MD, FACS, FAAO

Glad I found this. I've had visual snow since childhood, and migraines the last 7-8 years. The migraines bring on tinnitus, which brings light-headded spells. I've been dizzy for around 8 years now, and as a result have some pretty awesome anxiety issues. And now mood swings are a thing. This is severely life-impacting.

Been through ENTs, cardiologists, optometrists, etc. Sleep studies, CT scans, MRI's, you name it. Nobody has any idea what's wrong.

I've had visual snow since I was a child. I also get a lot of floaters. I do not get migraines often but a few times a year. I have gotten migraine with visual aura maybe 2 or three times in my life though.

The snow though has always been there, especially noticeable on dark ceilings at night or white walls.

I will add as well it seems to be hereditary possibly as my mother has it as well

=

This is an interesting post. At the Time I was diagnosed with visual snow in 2012 I was told there was no known cause. I've seen you comment on my posts which talk about my visual snow resolving with a hormone treatment addressing a fluid and electrolyte problem. I also discuss migraines, multiple, I've been diagnosed with. It's extra interesting because the two antiseizure meds I'm taking which somewhat help are lamotragine and gabapentin. I also had tinnitus until the gabapentin was added to the lamotragine. As you've seen on my other posts, my migraines and other visual symptoms persist but the visual snow has gone away. Thank you for posting this blog. I still don't know what = means. Does that mean you are following the post? It's a confusing reply.

I would love to have access to more information on this subject. Why is this term just popping up. I too have snow migraines, ocular migraines, visual abnormalities, balance and coordination issues ringing in my ears, language issues; and am being told it is all related to migraines. Really would be helpful to understand this condition better. From reading similar posts from others, we all seem worried something else is going on that is going to be missed. Just not enough out there for us to read and understand. Frustrating.

I can remember seeing the tiny spots since I was 10 or so. I have also had chronic neck pain, daily headaches and migraines up to 3-5x a week. I am 60 and was told 3 yrs ago that I have nuclear cataracts in both eyes but that they weren't ready for cataract removal surgery. I didn't need glasses until I was age 22 and then only for distance. I had a radial keratomy in my late 20's and it worked GREAT for almost 20 years (the last few years of this I did start having problems reading). From age 50+ I have had prescription glasses made but hardly ever wear them as they drive me crazy and make the headaches/migraines chronic pain issues worse. I do wear reading glasses when the print isn't dark enough or the font is elaborate or when there is insufficient lighting (directed lighting helps me minimize the need for reading glasses). I don't need glasses seeing on the computer. I also have dry eye syndrome. I have environmental sensory overload triggers (strong, flickering, night glare, fluroscent, etc.) lighting, strong odors, loud noises, weather changes (barometric pressure), crying/stress/anxiety, etc. and to avoid pain I spend a great deal of my life avoiding all of these issues by almost being totally housebound as I have to control my environment. I don't know if that is usual/common for those with visual snow. I have yet to find an opthamologist who even knows what visual snow is (I am looked at like I am a crazy exaggerating woman)….even in the Washington, DC/Northern VA/MD area. Any ideas??? Laura

Most likely the tiny spots you've seen since childhood are entophtic (entopic) phenomena. read the section on wikipedia on that. Your other symptoms can be explained by migraines, RK scars, dry eyes and cataracts. It is not at all likely that your compendium of symptoms is due to visual snow.

I have migraines (typical and atypical) visual snow, tinnitus and all the above symptoms theblondielou is describing. The VS and tinnitus is getting worser I think due to hormones. It is so difficult because dr. have no idea to live in a migrainious state without lying all day in bed. It is so awfull. I also have an early menopause at age 35 and 10 years before this my migraines changed. Some attacks lessend and others came instead. Last year I developed attacks with drooping eyelid and face, I got vertigo attacks with severe tinnitus, aura migraines. The aura migraines has lessened. I have tried hormones for years to balance and because at such young age I cannot live without but symptoms are getting worser. I have no idea what causes all this, menopause now or HRT. My gynaecologist is a little laconick about it: I also have migraines and than I just had to stop driving and after an hour everything is gone or I also have light tinnitus and you must not pay attention to it. I had normal tinnitus but when premature menopause was entering I got severe atttacks wit tinntitus, I can barely see clear in the evening, I have grammar problems, sensory overload, I have derealisation problems and feeling unreal because of this, odor problems, cannot concentrate anymore, cannot communicate long otherwise I get sick, I am light/sound sensitive and cyclic (month) symptoms increase/decrease. The only thing the neurologist can do is prescribing dekapine (lamotrigine didn't work in the past) Everybody ignores my neurological problems and I don't know what causes one and the other. Since my hormones changed I get al sort of neurological activity through my head. Tingling sensations neck, stiff shoulders... These come and go in attacks. I also have a lot of menopause symptoms and hrt is giving me problems I think. Do you have any idea who I can communicate this to my dr. Nobody has an idea what an awfull situation this state of migraine is. Hormones are the blame but doctors ignore the impact hormones have on this situation because they are not well known with these problems. I am afraid this hrt is causing much more problems dr. aren't unaware off. I can talk, walk, drive but still have severe symptoms 24 hours a day. So it is difficult to explain. They don't work together, neurologist and gynaecologist and I am falling between.

DVDM08 I personally have no experience in treating patients with VS and have rarely every had any patients have this complaints although they seem common on the internet.

Thank you for your answer! I thought you are also a doctor. I know this is common on the internet and dr. have no idea what we are talking about unfortunately. A lot of people, in particularly women, need more help, answers and awareness.

FIrst the article I posted is based on a lecture at a national meeting so 'attention is being paid to it." Second in the overall spectrum of why people come in to see an ophthalmologist it is a minuscule problem. I didn't say it wasn't a problem to you but it is a 'rare disease". If you have access to a world class tertiary care center such a Mayo Clinic or Cleveland Clinic you might want to consider a trip to a place that is a magnet for 'rare diseases".

Thank you for your answer. I live in The Netherlands so it I cannot go to the Mayo Clinic, unfortunatly. My neurologist knows what visual snow is and the they also are going to study this but the problem now is the effect early menopause has on the vs and migraines and trying hormones. At this point nobody works together and they al have their own specialism. That is difficult and to find a good dr. you have to pay a lot of money because most they work in private places.

While I don't have much experience with VS I am an active researcher on migraines. One thing I hope you know is that migraines tend to get better over time and most people eventually 'outgrown" them. After 40 migraines usually are more visual auras and less headache, nausea, vomiting, and 2-3 day 'wipe out" So it makes sense that VS might get worse during menopause. However most people the visual symptoms cease with migraine so maybe your VS will get better when menopause is over.

From what I am experiencing after my cataract surgery with both eyes set for distance, and having to only use reading glasses with the small fine print, my advice to you would be to get both eyes set for distance and use reading glasses.

Worked for you, doesn't work for many others. Different strokes for different folks

=

Doctor,

I contracted visual snow and likely HPPD after a period of heavy hallucinogen and psychedelic usage around two and a half years ago. I have abstained from hard substances since. My condition has stabalized, but not improved. Are you familiar with this cause and do you know if there are any cures for my condition?

I got visual snow when I got my first migraine headache. It started with a blind spot appearing in my eyes then to bright flashing lights that lasted about 30 minutes. Then I got a full fledged migraine. At the time I had no idea what was happening. After the migraine finally passed is when I started seeing the visual snow. It just appeared and has been with me ever since. I also developed tinnitus about 2 months after that. I had also suffered from floaters which had started getting worse. I also noticed the floaters seemed to make the visual snow worse so I finally had FOV surgery to remove the floaters. I still suffer from visual snow but at least I don't have the floaters on top of it. I also still suffer from migraines and tinnitus.

I just read your comment about migraines getting better with time. My migraines didn't start until I was 52 and I am now 64 and I still have them.

Basically only what is posted here. I have no personal experience in my practice with patients complaining of VS.

jkmartinex2: there are always exceptions. Be sure you have seen a neurologist to be sure everything that can be done is being done.

I agree very interesting subject. I have migraines with aura. When I was in my 20's I had silent migraine which consisted of attacks only at night of vomiting, and couldn't stop, with stomach pain and feeling cold or the shakes. I had to go to the ER for this. Then I was diagnosed with migraine, and had positive EEG and they gave me clonazepam. That totally cured the episodes. But in my 30's I started getting severe migraine with typical visual aura. The migraines changed again at about 50 less frequent and not as severe but then I got visual snow, and double vision. Also severe vertigo. I went to a ENT and checked hearing, and then went to a migraine specialist. Also, went to a Opthalmologist because of the eye issues to make sure nothing was wrong there. Both ENT and Opthalmologist said it was not an eye issue. My neurologist gave me cyproheptadine and I think Amitriptyline. That didn't work for anything. Then gave me Topiramate and that didn't work but Topamax (Topiramate XR) plus 10 mg Amitriptyline. did work for all the symptoms except the actual migraine. I was on it for 3 years and stabilized and then taken off because it gave me osteoporosis. But after begin off of the Topamax I have tinnitus and migraines with or without aura. But still no episodes of vertigo, snow or double vision. I am glad to be off of Topamax. It has very bad side effects. I watched the week seminar of the World Migraine Conference and it was very informative.
Now there is a new actual migraine medication out there for chronic migraine that is antibody based and also Botox.
Sorry this is long. But it is good for science to share and also it may help someone.
thank you,
mkh9

The migraine monoclonal antibodies are out of this world expensive. Thanks for your post.

hi
im 17 years old and I have panic disorder
my first panic attack was about 7 month ago AFTER THAT I FELT SO STRANGEEEE SO SO
I FELT LIKE IM NOT REAL OR NOTHING IS REAL AND WE ARE ALL IN A DREAM OR IN A ILLUSION . IN A normal situation im not feeling this whenever I feel like im tired or I have stress it comes to me and I scared a lot I feel like im going to be crazy . but whenever I don't have this feeling my mind trys to say that you are dreaming. I know that im not but there is a feeling inside of me which says that you are in a illusion and its so so so scares me. but the way im taking pills about 2 months I don't have stress I feeling better than pas actually but still have that feeling like im dreaming IM SO CONFUUUSSED
PLEASAE ANSWER TO ME I REALLY NEED SOMEONE TO TALK WITH IM FEELING SO ALONE THERE IS NO ONE TO TALK WITH

I'm not a psychiatrist. If you want to use the website go over to a psychiatric/panic group.

@emrosiee Sounds like what's called depersonalization and derealization; you're not alone and a bunch of other get this. Some think it has a connection to nmda receptors in the brain. If by any chance this started after an infectious illness, try to see a very up to date neurologist who can do some autoantibody testing.

and for everyone: on snow, i developed this along with an assortment of vessel issues including migraine with vertigo. only notice the snow when i wake up from overnight sleep or naps. But get other symptoms wasn't sure is connected with migraines. I can only describe them as "zaps" for lack fof better term. sensations of sudden jarring electric current in head, or sometimes feeling like an intense pressure building from inside extending outwards; only last a couple sseconds but very disruptive and typically happens during sleep. never could get any answers on that.

plus odd effects that seem like miagraine aura with a scotoma and sometimes surrounded by scintilatting lines. its not retinal, since i get identical thing with each eye. But the weird thing is instead of lasting only 20-30 minute, they are there overnight, every night, the entire 7 or so hours. haven't yet checked to see if maybe i'm in a darekened room lying down during day, i'd see them too. but really does seem like a scotoma since i can't see what's behind the black spot when i have it. could still be a migraine even tho so long lasting?

comments?

Not from me.

A man of few words. Oh well. Was hoping from a migraine perspective you might know whether all night long visual auras can occur? or whether those with migraines are more likely to report other sensations in head and not just pain? In your experience yes or no to those 2 questions? Thanks. (I am a prof in higher level vision btw)

I can be quite loquacious, especially if its something I've had a lot of experience with. I have never had a patient come into my office complaining of visual snow. So what I know is from reading about it and the posting here. Migraines a different matter, lots of experience with them. 1. No it would be highly atypical for a visual aura to last 8-12 hours. A neurologist would have to rule out other brain pathology such as atypical seizures, tumors, vascular abnormalities, etc. In this culture we live I would think of reaction to psychotrophic drugs. 2. Headache is typical of young migraine patients. Those with onset after 40 often have no pain or mild pain with their migraine. Yes some people report feelings they don't describe as pain. Again anything atypical needs a neurologist to rule out other pathology. Migraine is the last disorder to be diagnosed after all other causes have been eliminated.

So over the years I have had people come in attributing to migraine a whole variety of symptoms that after work up was due to brain tumors, seizures, cardiac and vascular disease, aneurysm, use of cannabis, meth, LSD, ketamine, ecstasy, IV heroin-morphine-dimerol , etc.

Interesting and helpful comments- thanks. On migraine as diagnosis of exclusion, I bet many patients' experiences are the flip side: they describe worrisome symptoms and the MD dismisses it as "just migraine".

Role of those drugs producing odd and migranous type side effects has troubling consequences for all. In these days of flowchart medicine, it means everyone is guilty until proven innocent; with that box closer to the top of the flowchart, slows down the process for the innocent.

(And to bring it back to the official topic of this thread, visual snow, the only thing i can add to the discussion is a good optho will say that it can happen with overheating; not sure how many of them know even that, let alone the migraine connection)

Thanks for your posts. will look for others. All sorts of interesting migraine related issues, but all off topic (e.g. any connections to "hot flashes" since both vascular, any connection to Alzhemiers, which is getting increasingly finally more recognized as a vascular illness, the interesting non-pain symptoms of migraines, like vertigo, the new monoclonal antibody treatment for migraine, the greater female predominance, even after menopause etc.)

This is a link to my migraine research (3 articles starts on page 520) We have tried for 5 years to get a pharmaceutical company to take interest in to a low cost, relatively safe, novel treatment for migraine. None are interested. they want the monoclonal CGRP antibodies which start at $8000/years

LINK: http://www.omagdigital.com/publication/?i=550690#{%22issue_id%22:550690,%22page%22:50}

I look forward to reading them. Thanks for the link. Certainly no surprise that big pharma not interested in inexpensive solutions. You should consider yourself lucky only your official research attempts have been thwarted by the western greed; some of us are dying because of it.

And such other odd consequences, like smart folk having to either self hack or seek out low IQ and uneducated (and often greedy as well) "alternative practitioners".

I was surprised btw that such a risky intervention like a monoclonal antibody was approved for migraine. LIke drug pushers, they give the first couple of doses for free - I know someone in that position, an 80+ year old woman  and now struggling to figure out if she is going to pay for treatment 3 and beyond.

You'll find a way to get your research done and out to the world. I'm a cynic just as you are;  Worth persisting anyway. Others of your species are out there...

Thanks for the comments

Just read them and enjoyed them. I guess in other papers you discuss possible mechanism - block sympathetic nervous system surges on cranial vessels??

Interesting you mention sublingual and intranasal delivery methods. Those are always my fave and I've fashioned assorted drugs into intranasal delivery especially when trying to reach certain regions. I was about to use agar agar for mucosal adhesion in the nasal cavity but stopped that particular exploration for other reasons.

I would think the side effects of any systemic reactions to the timilol or problems with any beta-only blocade would have already been well studied in glaucoma patients - assuming doses are the same. (I know not a substitue for making sure migraine patients don't bring any surprises, but still, gives one a sense).

YOu've gotten me re-thinking on using eye drops in other things, something that's occurred to me before (.e.g there's a mast cell stabilizer only available w/o compounding thru an eye drop).

From the other side again, note it's nearly impossible to get MDs to prescribe off-label drugs, even if you bring them a stack of really fine journal articles. Goes against "standard of care" - yet another nail in the coffin to the modern system.

You can blame that on the tort bar and malpractice lawyers. Every night on the news hour the commercials are all tort lawyers wanting clients to sue anyone doctors, hospitals, drug manufacturers, etc.

Good point. I've noticed an increasing shift last couple years that many MDs are acutely aware of potential lawsuits now and it seems to govern a great deal of their medical decision making - to the (usually) great detriment of patient health.

Also works it's way into the notes with all the EMR changes- the new endpoint of a med visit seems to be something they can put in the record that covers them against any lawsuit. Prestigious medical practices not exempt, and indeed, i've seen some of the biggest changes at univ affliated med groups that must be getting a great deal of pressure from above.

ok, i better stop co-opting this thread. Thanks for all your insights.

You are welcome

To quickly summarise the work that Dr. John Hagan referenced above: In a small study, timolol eyedrops at the first sign of migraine helped some sufferers reduce the severity and duration of their migraines. For context, timolol is a beta-blocker, and timolol tablets are used for migraine prevention. Timolol tablets aren't useful for migraines, but Dr. Hagan and the study authors hypothesize that that's because it takes too long for the timolol in pills to get into the bloodstream, whereas the timololol eyedrops deliver it quickly.

The drops are normally prescribed for glaucoma. They're pretty cheap. No pharmaceutical company is going to sponsor a study on timolol drops for migraine because timolol is an older medicine that's long out of patent protection.

If you suffer from migraines, don't have glaucoma, and want to try this, you could print out the articles and bring them to your opthalmologist or family doctor. Doctors can prescribe medicines off-label. This doesn't mean your doctor will decide it's right for you - they have to consider your health, the risks, your other medications, etc.



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