Author: Michael DeStefano, OD, Arlington Heights, Illinois, Optometrist, Visual Symptoms Treatment Center
Visual snow syndrome (VSS) is a neurological condition characterized primarily by the persistent perception of static-like dots across the entire visual field. In addition to this hallmark symptom, patients often experience a range of visual and non-visual disturbances.
This case report presents a 17-year-old male whose initial complaints were related to reading difficulties. Further investigation revealed a complex combination of visual, neurological, and psychological factors, ultimately leading to a diagnosis of VSS and a successful multimodal treatment approach.
Patient History
The patient presented with persistent reading difficulties that had previously been attributed to Irlen syndrome.
His medical and psychological background included:
- A diagnosis of ADHD in first grade, confirmed again in 2023
- A specific learning disorder with reduced phonetic awareness
- Long-term use of stimulant medication
- Chronic anxiety, linked to prior psychological trauma from bullying and physical abuse
Despite these known conditions, the patient had never reported several lifelong symptoms because he believed them to be normal.
Reported Symptoms
Reading-related symptoms
- Words appearing to move
- Blurry and double vision
- Difficulty maintaining place while reading
- Eyestrain and headaches
- Poor comprehension and concentration
- Difficulty with spelling and decoding
Previously unreported symptoms (later revealed)
- Static-like dots across vision (visual snow)
- Palinopsia and afterimages
- Tinnitus
- Streaks around lights
- Motion sensitivity (carsickness)
- Depersonalization
- Enhanced entoptic phenomena
Clinical Examination Findings
Initial testing showed normal basic visual function, including:
- 20/20 vision at distance and near
- Normal eye movements, pupil responses, and visual fields
- Normal color vision
- Unremarkable ocular health
- Refraction revealed only mild hyperopia and astigmatism.
However, functional testing uncovered:
- Binocular vision dysfunction
- Oculomotor deficits
- Convergence insufficiency
Treatment Approach
A comprehensive neuro-optometric treatment plan was implemented, consisting of:
- Vision therapy
- Chromatic filters (color-based lenses)
- Syntonic phototherapy (light therapy)
- Low-power prism lenses
Session 1 (May 30, 2024)
Focused on foundational visual skills:
- Brock string exercises
- Letter tracking
- Mental speed training
- Scan-search strategies
Session 2 (June 6, 2024)
Colour overlay testing was introduced:
- Green, turquoise, and peach overlays eliminated moving words
- Combination of green and turquoise improved both visual clarity and mental focus
Syntonic phototherapy trial:
- Mu-Upsilon (green): immediate calm, described as “the calmest he had ever felt.”
- Upsilon-Omega (deep blue): increased focus, slightly less relaxation
Session 3 (June 21, 2024)
Expanded syntonic therapy:
- Green (Mu-Upsilon): strong calming effect
- Violet (Neurasthenia): focused and attentive
- Deep blue/purple (Upsilon-Omega-Depressant): highly focused and moderately relaxed
Indirect sunlight enhanced effectiveness.
A daily syntonic protocol was prescribed:
- 5 minutes each of three filters (green → violet → blue/purple)
Session 4 (June 27, 2024)
Patient reported:
- Sustained benefits from syntonic therapy
- No anxiety or inattentiveness
- Improved reading clarity and comprehension
New activity:
- Convergence training using eccentric circles
Session 5 (July 11, 2024)
Improvements continued:
- No headaches, double vision, or blurry vision while reading
Performance gains:
- Completed visual tracing tasks with no errors
- Reading comprehension improved to the 50th percentile
Session 6 (July 18, 2024)
Assessment of motion sensitivity:
- Symptoms triggered by high-contrast and moving stimuli (pattern glare)
Intervention:
- 0.25 base-down prism reduced symptoms significantly
Additional testing:
- Green/Blue 20% tint combined with prism:
- Eliminated symptoms across all visual tasks
- Removed visual disturbances
- Increased calmness and focus
Colour preference findings:
- Green/blue tones consistently beneficial
- Red/orange worsened symptoms
Session 7 (July 25, 2024)
Confirmation of optimal correction:
- Combination of prism + green/blue tint eliminated:
- Visual snow
- Palinopsia
- Afterimages
- Light streaks
Prescription issued:
- Plano lenses with
- Green/Blue 20% tint
- 0.25 prism diopters (base-down)
Binocular function improved significantly.
Session 8 (August 1, 2024)
Patient received glasses and reported:
- Complete elimination of visual disturbances
- Improved attention and calmness
Objective reading performance testing confirmed improvement.
Follow-Up Evaluations
Progress Evaluation 1 (August 28, 2024)
- Continued improvement in:
- Attention
- Anxiety
- Reading ability
- Visual disturbances remained eliminated
- Vision therapy tapered off
Progress Evaluation 2 (February 2, 2025)
- Patient discontinued therapy exercises
- Symptoms remained resolved:
- No visual snow
- No anxiety
- Improved attention span
- Glasses used mainly for reading
- Reading without glasses improved compared to baseline
Discussion
This case highlights the effectiveness of combining multiple neuro-optometric interventions.
Key mechanisms:
- Chromatic filters:
- Green/blue tones stimulate the parasympathetic nervous system (calming)
- Red/orange stimulate the sympathetic system (stress response)
- Patient profile:
- ADHD, trauma, and anxiety suggest sympathetic overactivity
- Treatment shifted balance toward parasympathetic regulation
- Syntonic phototherapy:
- Uses light wavelengths to influence neurological and endocrine systems
- Different colors produce distinct physiological effects
- Pattern glare:
- Explains sensitivity to high-contrast patterns
- Reduced with prism and tint
This case demonstrates that VSS can be effectively treated using non-pharmacological, neuro-optometric approaches. The combination of vision therapy, chromatic filters, syntonic phototherapy, and prism lenses resulted in:
- Complete elimination of visual disturbances
- Resolution of anxiety and attentional difficulties
- Significant improvements in reading performance
Although responses to treatment may vary, this case highlights the potential for meaningful recovery in patients with VSS and highlights the need for greater clinical awareness and research into these therapeutic methods.