Visual Snow Syndrome Improves With Modulation of Resting-State Functional MRI Connectivity After Mindfulness-Based Cognitive Therapy: An Open-Label Feasibility Study

Wong, Sui H. MD, FRCP; Pontillo, Giuseppe PhD; Kanber, Baris PhD; Prados, Ferran PhD; Wingrove, Janet PhD, CPsychol; Yiannakas, Marios PhD; Davagnanam, Indran FRCR; Gandini Wheeler-Kingshott, Claudia A. M. PhD; Toosy, Ahmed T. PhD, FRCP

Background: 
Visual snow syndrome (VSS) is associated with functional connectivity (FC) dysregulation of visual networks (VNs). We hypothesized that mindfulness-based cognitive therapy, customized for visual symptoms (MBCT-vision), can treat VSS and modulate dysfunctional VNs.

Methods: 
An open-label feasibility study for an 8-week MBCT-vision treatment program was conducted. Primary (symptom severity; impact on daily life) and secondary (WHO-5; CORE-10) outcomes at Week 9 and Week 20 were compared with baseline. Secondary MRI outcomes in a subcohort compared resting-state functional and diffusion MRI between baseline and Week 20.

Results: 
Twenty-one participants (14 male participants, median 30 years, range 22–56 years) recruited from January 2020 to October 2021. Two (9.5%) dropped out. Self-rated symptom severity (0–10) improved: baseline (median [interquartile range (IQR)] 7 [6–8]) vs Week 9 (5.5 [3–7], P = 0.015) and Week 20 (4 [3–6], P < 0.001), respectively. Self-rated impact of symptoms on daily life (0–10) improved: baseline (6 [5–8]) vs Week 9 (4 [2–5], P = 0.003) and Week 20 (2 [1–3], P < 0.001), respectively. WHO-5 Wellbeing (0–100) improved: baseline (median [IQR] 52 [36–56]) vs Week 9 (median 64 [47–80], P = 0.001) and Week 20 (68 [48–76], P < 0.001), respectively. CORE-10 Distress (0–40) improved: baseline (15 [12–20]) vs Week 9 (12.5 [11–16.5], P = 0.003) and Week 20 (11 [10–14], P = 0.003), respectively. Within-subject fMRI analysis found reductions between baseline and Week 20, within VN-related FC in the i) left lateral occipital cortex (size = 82 mL, familywise error [FWE]-corrected P value = 0.006) and ii) left cerebellar lobules VIIb/VIII (size = 65 mL, FWE-corrected P value = 0.02), and increases within VN-related FC in the precuneus/posterior cingulate cortex (size = 69 mL, cluster-level FWE-corrected P value = 0.02).

Conclusions: 
MBCT-vision was a feasible treatment for VSS, improved symptoms and modulated FC of VNs. This study also showed proof-of-concept for intensive mindfulness interventions in the treatment of neurological conditions.

Published online 2023 May 30. doi: 10.2217/cnc-2023-0006
PMCID: PMC10498816
PMID: 37711469
Neuro-optometric treatment for visual snow syndrome: recent advances
Kenneth J Ciuffreda, Barry Tannen, Daniella Rutner, and MH Esther Han 

"In conclusion, the condition of visual snow syndrome, which is found is found in approximately 2% of the general population, has received considerable attention over the past decade by both clinicians and researchers. Fortunately, two neuro-optometric rehabilitative approaches have benefitted most patients. This has included colored filters and eye movement procedures to reduce the perception of the visual snow and some of the other related visual disturbances, such as light sensitivity."