Neuro-ophthalmic findings of Visual Snow Syndrome in Korea

To investigate the neuro-ophthalmologic characteristics, potential triggers, and treatment responses of visual snow syndrome (VSS) in a Korean population.

Retrospective case series.

We retrospectively reviewed the data of patients diagnosed with VSS at a tertiary hospital from March 2021 to February 2024. Data on visual and nonvisual symptoms, self-reported events that caused VSS, and medical and psychiatric comorbidities were chart-reviewed. Neuroimaging findings from MRI and ¹⁸F-FDG PET were evaluated, along with treatment responses to pharmacological interventions and filter glasses.

The sample comprised 27 men and 36 women, with a mean age of 27±11 years (mean±SD) and onset age of 22.4±11 years. Common symptoms included floaters, palinopsia, anxiety, and depression. Fourteen participants attributed VSS onset to specific ophthalmic events (e.g. refractive surgery or ophthalmic examinations with bright-light). ¹⁸F-FDG PET scans showed hypermetabolism in the visual cortices (81.8%), with no significant MRI abnormalities. Lamotrigine (18.9%), alprazolam (20%), and filter glasses (32.1%) showed modest efficacy in reducing the intensity of VSS.

Korean patients with VSS exhibited clinical features, neuroimaging findings, and treatment responses similar to those reported in Western populations. Ophthalmic procedures, such as refractive surgery and bright-light examinations, may act as potential triggers in susceptible individuals. Although functional imaging, including ¹⁸F-FDG PET, may be useful for evaluating VSS, further studies with healthy controls and quantitative analyses are needed to validate its diagnostic value. Given the modest treatment efficacy, a multidisciplinary approach combining pharmacological intervention, filter glasses, and psychological support is essential to optimize outcomes.