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John C Hagan III, MD, FACS, FAAO  
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VISUAL SNOW UPDATE: 2018

Apr 16, 2018 - 24 comments

This material is from the April 1, 2018 issue of Ophthalmology Times medical newsletter. The title of the article is "Migraine Pain More Than A Headache" and is based on The Hoyt Lecture given at the 2017 meeting of the American Academy of Ophthalmology by Kathleen B. Digre, MD a neuro-ophthalmologist from University of Utah.

Patients with various forms of migraine have an increased incidence of "visual snow".  NOTE VIP: "The proposed criteria for visual snow that were developed include: dynamic, continuous dots in the visual field for at least three months and the presence of at least two other visual phenomena and palinopsia, enhanced entoptic phenomenon, and at least one of the following: excessive floaters, or 'self-light of the eye' or photopsia, photophobia and nyctalopia.  

As many as 59% of migrane patients may have visual snow. And 87% of visual snow patients have some problem with headaches. 25% of people have had visual snow since childhood.

Treatment is often not necessary as many people learn to ignore the symptoms. Medications that sometimes help: lamotrigine, nortriptyline,carbamazepine and sertraline.  Sometimes glasses with blue/yellow filters or FL-41 spectrum filters are helpful.  The complete article might be available for viewing on the Ophthalmology Times website previous issues this is Volume 43 #6  4/1/18



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Avatar universal
by SJL2018, Apr 23, 2018
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.  

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by JohnHaganMD, Apr 23, 2018
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


Avatar universal
by foomanjee, Apr 27, 2018
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.

Avatar universal
by Nevi2017, May 25, 2018
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.  

Avatar universal
by Nevi2017, May 25, 2018
I will add as well it seems to be hereditary possibly as my mother has it as well

Avatar universal
by phelyne, Jun 07, 2018
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.

Avatar universal
by Kbr27, Jun 10, 2018
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.

Avatar universal
by theblondielou, Jun 28, 2018
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.

Avatar universal
by dvdm08, Jul 07, 2018
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.

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by JohnHaganMD, Jul 07, 2018
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.

Avatar universal
by dvdm08, Jul 08, 2018
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".



Avatar universal
by dvdm08, Jul 09, 2018
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.

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by JohnHaganMD, Jul 09, 2018
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.

Avatar universal
by william1954, Jul 15, 2018
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.

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by JohnHaganMD, Jul 15, 2018
Worked for you, doesn't work for many others.  Different strokes for different folks

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by JohnHaganMD, Jul 19, 2018
=

Avatar universal
by Kidmulso, Jul 27, 2018
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?

Avatar universal
by jkmartinez2, Jul 28, 2018
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.  

Avatar universal
by jkmartinez2, Jul 28, 2018
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.  

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by JohnHaganMD, Jul 28, 2018
Basically only what is posted here. I have no personal experience in my practice with patients complaining of VS.

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by JohnHaganMD, Jul 28, 2018
jkmartinex2: there are always exceptions.   Be sure you have seen a neurologist to be sure everything that can be done is being done.

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