Neuro-Optometric Rehabilitation Therapy (NORT)

Neuro-Optometric Rehabilitation Therapy (NORT) for Visual Snow Syndrome

Welcome to our guide on Neuro-Optometric Rehabilitation Therapy (NORT) for Visual Snow Syndrome (VSS). This guide offers detailed information about NORT, including its definition, underlying mechanisms, and its potential role in managing VSS symptoms based on current research and clinical practice.

What is Neuro-Optometric Rehabilitation Therapy (NORT) for Visual Snow Syndrome (VSS)?

Neuro-Optometric Rehabilitation Therapy (NORT) is a non-invasive, individualized therapeutic approach aimed at addressing visual deficits associated with various neurological and neuro-ophthalmological conditions, including Visual Snow Syndrome (VSS). The therapy focuses on retraining the brain’s visual processing mechanisms through the use of specialized lenses, prisms, filters, and targeted eye exercises. These interventions are tailored to each patient based on their specific symptoms and medical history.

In individuals with Visual Snow Syndrome, reducing strain on the visual system can help lower cortical hyperexcitability and overall neurological load. This facilitates more efficient visual processing and allows the brain to better adapt to incoming sensory input. By limiting unnecessary or competing visual stimuli, perceptual demand decreases, supporting neuroplastic mechanisms and potentially reducing the severity or frequency of additional visual disturbances.

Research indicates that individuals with VSS who undergo NORT may experience improvements in several areas, including:

Visual Disturbances: Reduction in symptoms such as visual snow, palinopsia (afterimages), and other related visual disturbances.
Eye Movement: Improvement in eye movement coordination and visual processing efficiency.
Mental Health: Decrease in anxiety, depression, and stress associated with visual disturbances.
Daily Functioning: Enhanced ability to perform activities like reading, driving, and other tasks requiring visual focus.
Quality of Life: Overall improvement in daily functioning, social interactions, and quality of life.

NORT offers a therapeutic option for individuals with VSS, focusing on symptom management and improving daily living.

What Does Neuro-Optometric Rehabilitation Therapy (NORT) Involve for Visual Snow Syndrome (VSS)?

The standard NORT protocol for individuals with Visual Snow Syndrome typically consists of a 12-week course of in-person, one-on-one therapy sessions, each lasting approximately one hour.

Patients undergo a comprehensive in-office evaluation using advanced optometric techniques to assess visual function. This includes analysis of ocular motility, fixation, and binocular vision to identify potential dysfunctions contributing to visual symptoms.

Each session incorporates 3 to 5 targeted visual exercises, complemented by customized at-home assignments. Home-based exercises are performed five days per week over the 12-week period and are reviewed regularly during follow-up visits to monitor progress. All therapeutic activities are selected by the prescribing optometrist based on the individual’s clinical profile, symptom presentation, and medical history.

For additional clinical information and a detailed overview of the NORT protocol, refer to the peer-reviewed study by Dr. Charles Shidlofsky, Dr. Terry Tsang, and Vanessa Mora: “The Efficacy of Neuro-Optometric Visual Rehabilitation Therapy in Patients with Visual Snow Syndrome”, published in Frontiers in Neurology.

Who Provides Neuro-Optometric Rehabilitation Therapy (NORT) for Visual Snow Syndrome?

NORT is administered by a licensed neuro-optometrist or a certified vision therapist operating under the supervision of a neuro-optometrist. Treatment protocols are individualized and tailored to each patient’s unique symptom profile, aligning with established clinical guidelines.

Important Note: When seeking care, it is recommended to confirm that the provider has experience working with individuals diagnosed with Visual Snow Syndrome, is familiar with the condition’s clinical presentation, and offers NORT specifically as a therapeutic approach for VSS-related visual disturbances.

How Can I Find a Doctor Who Provides NORT for Visual Snow Syndrome (VSS)?

Doctors and Researchers with Expertise in Neuro-Optometric Rehabilitation Therapy (NORT) for Visual Snow Syndrome (VSS)

Dr. Terry Tsang and Dr. Charles Shidlofsky have led the development of international VSS Masterclasses to educate healthcare professionals about Visual Snow Syndrome (VSS) and train them in delivering Neuro-Optometric Rehabilitation Therapy (NORT) for VSS-related symptoms. These educational programs are designed to increase clinical understanding of VSS and expand global access to NORT.

The VSS Masterclasses are affiliated with the Council on Optometric Practitioner Education (COPE), a continuing education accreditation program overseen by the Association of Regulatory Boards of Optometry (ARBO). Through these initiatives, Dr. Tsang and Dr. Shidlofsky aim to advance professional training, enhance treatment options, and improve quality of care for individuals affected by VSS worldwide.

VSI Directory

The Visual Snow Initiative (VSI) offers a directory of medical professionals who are knowledgeable about Visual Snow Syndrome (VSS) and provide Neuro-Optometric Rehabilitation Therapy (NORT). This includes providers who have completed the VSS-NORT Physician Masterclass.

NORA Provider List

The Neuro-Optometric Rehabilitation Association (NORA) maintains a directory of healthcare providers who offer NORT. However, not all listed professionals may be familiar with or trained specifically in treating VSS.

ACBO Provider List (Australia & New Zealand)

For individuals with VSS in Australia and New Zealand, the Australasian College of Behavioural Optometrists (ACBO) website includes a list of providers certified to deliver NORT for VSS in those regions.

Saccadic Training in Visual Snow Syndrome (VSS)

Saccades are rapid, coordinated eye movements that allow the eyes to shift focus between objects. They are essential for visual tasks such as reading, scanning, and tracking motion.

Individuals with Visual Snow Syndrome (VSS) often exhibit atypical saccadic behavior. Studies indicate that VSS patients may display increased saccadic intrusions, including premature eye movements toward irrelevant stimuli—resulting in a higher rate of antisaccade errors. These errors occur when the eyes involuntarily move toward a non-target cue, even when the individual is instructed to maintain focus elsewhere.

This difficulty in maintaining attentional control and visual focus may stem from cortical hyperexcitability within visual processing areas and altered connectivity in neural pathways responsible for filtering visual input. As a result, individuals with VSS may find it challenging to suppress distracting visual cues, leading to unstable or inefficient eye movement patterns.

Saccadic training is used within Neuro-Optometric Rehabilitation Therapy (NORT) to address these challenges. By targeting and improving the brain’s ability to regulate saccadic movements, this training supports visual stability, enhances focus, and helps individuals with VSS better manage visual disturbances in daily life.

Key exercises include:

4 Chart Saccade: Improves eye control by training quick, precise eye movements.
Wall Saccade with T-Step: Combines eye movement with body shifts for better balance and orientation.
Central-Peripheral Saccades: Enhances awareness of side vision, helping reduce disorientation.
3 Chart Wall Saccades: Improves the ability to organize and track visually while maintaining peripheral awareness.

Common Exercises and Methods in Neuro-Optometric Rehabilitation Therapy (NORT)

Vision Therapy Exercises

Tracking Exercises: These exercises focus on improving the ability to track moving objects smoothly. They can help with eye coordination, reducing symptoms like double vision or difficulty focusing.
Saccadic Eye Movements: Exercises designed to enhance the speed and accuracy of eye movements when shifting gaze between points, improving reading ability and visual processing speed.
Convergence Exercises: These exercises aim to strengthen the ability of both eyes to focus on a single point, addressing issues like eye strain and blurred vision.

Prism Lenses

Flippers

Flipper Lenses: These are special lenses used in vision therapy exercises to help improve the flexibility and strength of the eyes. Flippers are typically used to alternate between near and far vision rapidly. They are often used for exercises to train the eyes to adjust to changing focal distances, which can help with symptoms like blur and difficulty focusing. The exercises can improve convergence, accommodation (focusing ability), and overall visual clarity.

Patching

Patching: Patching one eye or part of the visual field of one eye is sometimes used to help those with double vision. The patch is placed to eliminate the information that results in the double image from reaching the brain. This helps the brain to process a single, clear image. The patch is frequently placed directly onto the lens surface or worn over one eye to reduce visual confusion and provide temporary relief.

Visual Perception Training

Eye-Hand Coordination Training

Balance and Posture Training

Neurofeedback

Light Sensitivity Management

Visual Field Training

Peripheral Vision Exercises: Exercises designed to improve the awareness and use of peripheral vision, helping individuals who have difficulty detecting objects outside of their direct line of sight.
Scotoma Training: For individuals with visual field deficits, exercises to train the brain to compensate for blind spots and improve overall visual perception.

And More

When used in combination, these methods may help improve visual and cognitive function in individuals with Visual Snow Syndrome (VSS), particularly those experiencing persistent visual symptoms. Potential benefits may include a reduction in symptom severity and enhancements in daily functioning and overall quality of life. However, treatment protocols and outcomes can vary depending on the neuro-optometric rehabilitation provider and the individual characteristics of each case. As such, all management strategies should be personalized and based on a thorough assessment of the patient’s symptoms, visual function, and medical history.

Why Reducing Visual Strain Matters in Visual Snow Syndrome (VSS)

The Role of Visual Strain in VSS

In individuals with Visual Snow Syndrome, reducing strain on the visual system is essential for lowering cortical hyperexcitability and easing the brain’s overall neurological load. VSS involves increased activity in the visual cortex which can intensify visual disturbances and contribute to sensory overload. Reducing this strain helps the brain process visual input more efficiently and adapt to sensory stimuli more effectively.

How Visual Input Affects the Brain

Minimizing unnecessary or conflicting visual input decreases perceptual demand and eases sensory strain. This reduction in visual overload supports neuroplastic adaptation, the brain’s natural ability to reorganize and adjust to sensory changes. These adaptive processes may improve visual stability and reduce the frequency or severity of additional visual symptoms.

Benefits of Lower Visual Strain

When the visual system is under less stress, the brain requires less effort to interpret visual information. This can lead to increased comfort, less cognitive fatigue, reduced sensory overload, and a more manageable visual experience for those living with VSS.

Patient Experiences with Neuro-Optometric Rehabilitation Therapy (NORT) for Visual Snow Syndrome (VSS)

Living with Visual Snow Syndrome:
Eric Hilton’s Journey & Search for Relief

Eric Hilton, a U.S. veteran and former Special Operations Medic, has lived with Visual Snow Syndrome (VSS) for over 20 years following a traumatic brain injury caused by an IED blast.

With limited resources available, Eric has faced ongoing visual static, sensory disturbances, and cognitive challenges that deeply impact his daily life. In this video, Eric travels from Maine to Texas to pursue Neuro-Optometric Rehabilitation Therapy (NORT), a 12-week treatment option tailored to his VSS symptoms and medical history.

Watch as Eric shares his honest experience living with this multifaceted neurological condition—and his hope for progress.

VSS-NORT Masterclass Videos: Educational Resources for Physicians

VSS Masterclasses

9 Videos