On March 20, 2019, the Visual Snow Initiative (VSI) presented a $125,000 check to the University of Colorado’s research team, led by Dr. Victoria Pelak, to fund an open-label pilot treatment trial (COMIRB #: 20-0424) investigating transcranial magnetic stimulation (TMS/rTMS) for Visual Snow Syndrome (VSS). TMS/repetitive TMS (rTMS) is a non-invasive brain stimulation technique that has shown benefits in several neurological disorders, including chronic tinnitus. Dr. Pelak, Professor of Neurology and Ophthalmology at the University of Colorado Anschutz Medical Campus and the study’s principal investigator, aimed to evaluate the effectiveness of rTMS in improving symptoms, visual function, and quality of life for individuals diagnosed with VSS.
Dr. Pelak commented: “Our neuro-visual research group at the University of Colorado School of Medicine is extremely grateful for the support, and we are busy planning the research trial. Without VSI’s support, this study would not have been possible. We expect to have results after 18 months and look forward to sharing them with the scientific community.”
Study Protocol Published
VSI announced that the study protocol was published in Frontiers, a peer-reviewed, open-access journal, on September 24, 2021, under the title “A Study Protocol for an Open-Label Feasibility Treatment Trial of Visual Snow Syndrome With Transcranial Magnetic Stimulation” (Grande, Lattanzio, Buard, McKendrick, Chan, and Pelak, 2021). The protocol outlined the pilot study’s objectives, including evaluating adverse events and dropout rates, testing outcome measures (including a novel VSS symptom scale), and describing changes in outcomes following rTMS intervention. By sharing the protocol, the team enabled other researchers to replicate or expand upon the study, further advancing VSS research.
Unforeseen Challenges During the Pandemic
The Covid-19 pandemic caused significant delays and challenges for the study. (Full details can be found in the published article.) Recruitment and in-person participation were affected by travel restrictions, work obligations, and the requirement for participants to attend treatment five days per week for two consecutive weeks. Some participants were also ineligible due to the absence of a brain MRI (in the past three years), which was specified as an eligibility requirement for study participants before rTMS was performed. This necessitated additional scans before participation. The research team also adjusted the protocol to allow occasional missed days and extended the study timeline, requiring additional financial support to maintain salaries and resources.
“This open-label treatment trial of rTMS for VS syndrome is ongoing, and results will be used to inform the feasibility and utility of a future randomized, controlled trial of rTMS for VS syndrome. The greatest challenge faced in the ongoing study has been difficulty with recruitment during to the Covid-19 pandemic. However, with decreasing Covid-19 restrictions within the United States and the increase in Covid-19 vaccinations in Colorado, there is renewed interest in participation in the study by those previously screened. Given the recent progress to date, the current aim is to complete enrollment by June 2022.” (Grande, Lattanzio, Buard, McKendrick, Chan, and Pelak, 2021.)
Although the study experienced delays due to the Covid-19 pandemic, Dr. Pelak noted that it remained underway and that the final results would be published once her team completed their research. The research team worked diligently to adapt to pandemic-related challenges, adjusting procedures as needed to continue the study. As a result of these adjustments, the team estimated that enrollment would be completed by 2022.
Research Progress & Preliminary Insights
Valuable insights emerged from the study protocol and early findings. Publishing the protocol enabled other global researchers to replicate or expand upon the work, contributing to the broader understanding of VSS and the potential utility of rTMS. VSI’s Director of Research, Vanessa Mora, interviewed Dr. Pelak in “Current & Ongoing Visual Snow Syndrome Research and Insights by Dr. Victoria Pelak“, highlighting observations, study protocol details, and preliminary recommendations for patients.
In 2023, “Repetitive TMS Pilot Trial for Visual Snow Syndrome: Adverse Event Report” was published in Brain Stimulation. The pilot study report evaluated brain stimulation (rTMS) in people with Visual Snow Syndrome, focusing on safety while also providing preliminary, non-conclusive insights into its effects. The study found that rTMS was generally well tolerated, with mild side effects such as headaches or tingling and no serious adverse events. While safety was the primary focus, some participants experienced reduced visual snow and possible improvement in other sensory symptoms, but others did not, and responses varied. Because VSS affects people differently, this variability made it difficult to generalize the results. At the time, it was too early to draw firm conclusions about effectiveness without full data analysis and expert interpretation by the researchers.
Updates Received from Dr. Pelak
January 2024: Dr. Pelak reported that the next step is to review the study outcomes, with more information expected after spring (March 19-June 20, 2024, U.S.).
July 8, 2024: The target for completing all data analysis was updated to September 30, 2024.
October 4, 2024: Dr. Pelak and her team were finalizing data and preparing manuscripts on TMS and outcome measures, aiming for submission by year-end. Acceptance for publication was estimated to take approximately four months.
February 27, 2025: Due to delays, Dr. Pelak aimed to finalize the data during the summer (July).
August 12, 2025 – ongoing: Dr. Pelak continues to oversee the research alongside her academic and clinical responsibilities, reporting that the July data finalization has been completed and results have been formalized. Peer review and publication will follow, and VSI will share any further updates it receives from her team on this work.
April 2, 2026 onward — Study complete, publication pending, per Dr. Pelak
Dr. Victoria Pelak’s rTMS/TMS study is complete and pending publication. VSI funded the initial study in 2019 and later offered additional support in 2024-2025 to help expedite publication. However, Dr. Pelak has chosen to manage publication and dissemination independently. As lead investigator, she continues to oversee the research and is responsible for completing data analysis prior to peer review. We respect her decision and understand how challenging and sometimes frustrating it can be to wait for results, as research in VSS requires balancing clinical responsibilities, academic work, thorough data review, and coordination with publishers and final approvals. The COVID-19 pandemic also affected participant recruitment and study timelines. Some findings from this work, as well as Dr. Pelak’s additional studies on assessment tools for VSS, have already been published. We are grateful for Dr. Pelak and her team’s contributions to VSS research and awareness and the valuable insights gained through their studies. VSI will continue to share updates as they become available or if additional information is released.
Additional details about future directions of Visual Snow Syndrome TMS research can be found below.
To continue advancing VSS research, VSI is collaborating with teams across Europe, including Switzerland, Spain, and Portugal, who are conducting neuromodulation and TMS studies and sharing the results when they are published. These efforts ensure ongoing progress while VSI continues to advocate for and facilitate research aimed at improving understanding and treatment of Visual Snow Syndrome. Emerging research on TMS for neurological and neuro-ophthalmological conditions also continues to advance the field and will continue to contribute valuable insights and help push the field forward. Thank you for your continued patience and support as VSS research progresses. We look forward to sharing any future findings as they become available and published by researchers.