John C Hagan III, MD, FACS, FAAO  
Kansas City, MO

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Apr 16, 2018 - 3 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.  

177275 tn?1511758844
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.

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