Visual Snow Syndrome in Saudi Arabia: A Cross-Sectional Study Assessing Prevalence, Symptomatology, Awareness, and Associated Factors

Visual snow syndrome (VSS) is characterized by persistent visual disturbances, predominantly visual static or noise, accompanied frequently by afterimages, photophobia, and impaired night vision [1]. Despite gaining international recognition, VSS remains widely underdiagnosed and often misdiagnosed as migraine aura, hallucinogen-persisting perception disorder (HPPD), or other neuro-ophthalmologic conditions [2–4]. Diagnostic criteria primarily depend on self-reported symptoms due to the current absence of objective biomarkers, which complicates accurate diagnosis and management [1].

Current evidence suggests that VSS originates from widespread cortical hyperexcitability involving visual and thalamocortical networks, as confirmed by functional neuroimaging studies indicating cortical dysfunction beyond visual pathways, including the attentional and limbic areas [5,6]. This neurological basis underpins the complex symptomatology observed in VSS.

Prevalence estimates for VSS vary, with studies from Europe reporting rates of between 2% and 5%. These variations are influenced by differences in the diagnostic criteria and study methodologies [7–9]. Notably, there is a paucity of data regarding the prevalence and characteristics of VSS in Middle Eastern populations, including those in Saudi Arabia. This lack of regional research highlights the need for studies focused on these communities to better understand the impact of the syndrome and inform appropriate clinical responses.

VSS frequently co-occurs with conditions such as migraines, tinnitus, anxiety, and depression [2,10,11]. These comorbidities suggest a broader neurological and psychological interplay that warrants comprehensive investigation. Furthermore, lifestyle factors such as prolonged screen time and reduced physical activity have been hypothesized to influence symptom severity, although empirical evidence remains limited.

The evident gaps in clinical awareness and understanding of VSS, especially in underrepresented regions, underscore the necessity for targeted educational initiatives and research efforts. Conducting studies within diverse populations will not only enhance the global comprehension of VSS, but also contribute to the development of effective diagnostic and management strategies tailored to specific community needs.

Study Design

A cross-sectional, descriptive study design was used, employing an online, self-administered questionnaire to collect data. This survey aimed to gather insights into the symptomatology, awareness levels, and factors associated with Visual Snow Syndrome (VSS) among the Saudi population.

Participants

Participants included individuals residing in Saudi Arabia recruited via convenience sampling through online platforms and social media channels. The Inclusion criteria were adults aged 18 years or older, capable of providing informed consent, and able to complete an online survey independently.

Data Collection Tool

An electronic questionnaire was developed based on previous studies and the validated literature. The questionnaire consisted of multiple sections covering the following:

• Demographic data (age, gender, region, education, and occupation)
• Awareness of VSS and sources of information
• Symptomatology, specifically assessing visual snow, afterimages, photophobia, and night blindness.
• Associated medical conditions (e.g., migraine, anxiety, tinnitus, and depression)
• Lifestyle and environmental factors (screen time, physical activity, and tobacco use)
• Impact on daily activities, symptom duration, and stress effects

Data Collection Procedure

The finalized questionnaire was distributed electronically through social media platforms, healthcare forums, and direct contact between specific dates. The participants voluntarily completed the online survey after providing informed consent. Anonymity and confidentiality were ensured throughout the data-collection process.

Data Analysis

Data were analyzed using descriptive and inferential statistical methods using SPSS (version 28). Descriptive statistics, including frequencies, percentages, and means, were calculated to summarize demographic characteristics, symptom prevalence, and awareness levels. Fisher’s exact test and chi-square test were used to assess the potential associations between the presence of VSS and demographic or lifestyle variables. Statistical significance was set at p<0.05.

Ethical Considerations

Ethical approval was obtained from the relevant institutional review board prior to data collection. Participation was entirely voluntary, and respondents were informed of their right to withdraw at any point without consequences. All collected data were stored securely and accessible only to authorized research personnel.

A total of 343 participants were included in this study. Most participants were aged 18–24 years (37%), followed by those aged 25–34 years (30.9%). The majority (76.1%) were female. Regarding region of residence, 57.4% resided in the Northern region, followed by 29.7% in the Central region. In terms of education, 72.9% of participants held a bachelor’s degree. Professionally, 48.4% were non-healthcare professionals and 32.9% were students (Table 1).

Table 1: Distribution of Participants according to Demographic Characteristics

Regarding awareness of the VSS, only 44 participants (12.8%) had heard of the condition. Among them, 59.1% learned about it from the media, 20.5% from healthcare professionals, 18.2% from friends or family, and 2.3% from other sources (Table 2).

Table 2: Participants awareness of VSS

With respect to the distribution of symptoms, 13.1% of the participants reported experiencing visual snow (static) in their vision, 32.7% reported seeing afterimages after looking away from objects, 10.2% reported difficulty seeing at night (night blindness), and 30.6% reported sensitivity to light (photophobia). Additionally, 8.5% reported both visual snow and afterimages, 3.2% experienced both visual snow and night blindness, and 7.3% experienced both visual snow and sensitivity to light. Furthermore, 2.9% experienced visual snow, afterimages, and night blindness; 5.2% reported visual snow, afterimages, and sensitivity to light; and 2.3% experienced visual snow, night blindness, and light sensitivity. Finally, 2.0% of the participants reported experiencing all four symptoms: visual snow, afterimages, night blindness, and light sensitivity (Figure 1).

Figure 1: Distribution of Participant according to Presence of Vss Symptoms

The results indicated a VSS prevalence of 3.8% with a 95% confidence interval of 1.8%–5.8% (Table 3).

Table 3: Prevalence of VSS

Fisher’s exact test was used to assess the significance of the association between the VSS and demographic characteristics. The results showed no significant associations between VSS and demographic characteristics at the 0.05 significance level, suggesting that participants had a similar prevalence of VSS regardless of their age, gender, region of residence, occupation, or educational attainment (Table 4).

Table 4: Association between VSS prevalence and the demographic characteristics:

Considering the associated conditions, 17.5% of the participants reported experiencing migraines, 11.1% reported tinnitus, 20.4% reported anxiety, and 5% reported depression. Regarding neurological conditions, 1.5% of the participants were diagnosed with neurological disorders (Table 5).

Table 5: Associated Health Conditions

Regarding lifestyle patterns, 39.7% of participants reported an average daily screen time of 5–7 hours, while 31.8% reported 2–4 hours. In addition, 8.2% of the participants reported using tobacco products. In terms of physical activity levels, 47.2% were slightly active, 28.3% sedentary, and 22.7% moderately active (Table 6).

Table 6: Lifestyle Patterns

When investigating additional aspects related to VSS symptoms, 3.8% of participants reported having experienced significant head trauma, and 1.5% had used hallucinogenic or psychoactive drugs. Moreover, 16.3% had a family member with similar visual disturbances and 15.2% had previously sought medical help for visual disturbances. Regarding the frequency with which visual symptoms affected daily activities, approximately 28% reported that symptoms sometimes impacted their activities, whereas approximately 6.9% reported being often or always affected. In terms of symptom duration, 9.3% had experienced symptoms for less than one year, while 5.8% had experienced them for one year or longer. Furthermore, 7.6% of the participants reported that changes in stress levels influenced their symptoms (Figure 2).

Figure 2: Additional Aspects

This study provides important insights into the prevalence, symptomatology, awareness, and associated factors of Visual Snow Syndrome (VSS) in the Saudi Arabian population. Our findings indicate a prevalence of approximately 3.8%, aligning closely with the international prevalence estimates ranging from 2% to 5% [7–9]. Despite the methodological limitations associated with using a convenience sampling method through social media distribution, this estimated prevalence provides essential preliminary data specific to the Saudi context and highlights the relevance of the VSS within this population.

Awareness of VSS among respondents was notably low, with only 12.8% previously aware of the condition, primarily gaining knowledge through the media rather than through healthcare professionals. This limited clinical and public awareness aligns with global trends and underscores a significant barrier to accurate diagnosis and effective management [6,7]. This highlights the urgent need for targeted educational efforts aimed at both health care providers and the general public to improve early recognition and appropriate clinical responses [12,13].

Symptom analysis revealed that afterimages (32.7%) and photophobia (30.6%) were the most common visual disturbances, followed by snow (13.1%) [10]. The frequent occurrence of multiple simultaneous symptoms underscores the complex neurological underpinnings of VSS, consistent with the existing literature proposing cortical hyperresponsivity involving the visual and broader thalamocortical networks [5,14].

Significant comorbid conditions were reported among respondents, including migraine (17.5%), anxiety (20.4%), tinnitus (11.1%), and depression (5%), confirming the findings of previous international studies [8,11]. These associations strengthen the conceptualization of the VSS as part of a broader neurophysiological spectrum involving multisensory hypersensitivity [10,15]. Consequently, clinicians should adopt a multidisciplinary approach to ensure effective management.

Lifestyle factors, such as extended screen exposure and lower levels of physical activity, were prevalent among the participants, although the causative conclusions cannot be drawn from this cross-sectional study [16,17]. Nevertheless, this association warrants further longitudinal investigation to explore potential modifiable lifestyle interventions [18].

The reported family history of visual disturbances in 16.3% of the respondents suggests potential genetic predispositions or shared environmental triggers, consistent with the current hypotheses in the literature [10,19]. This aspect highlights the necessity for further genetic and familial research to better understand hereditary components and environmental contributions to VSS.

Moreover, approximately 8% of the respondents indicated that stress significantly exacerbates their symptoms, aligning with the evidence linking stress to symptom worsening in sensory-processing disorders [20]. Integrating stress management and psychological support into patient care strategies may be beneficial [16,18].

Limitations

The key limitations of this study include the use of convenience sampling through social media platforms, introducing potential selection bias, and limiting generalizability. Additionally, reliance on self-reporting without clinical verification introduces potential recall and response bias [10].

Recommendations and Future Research

Future studies should employ randomized population-based sampling and incorporate the clinical validation of symptoms to enhance accuracy and generalizability. Longitudinal research is recommended to clarify the symptom progression, causal relationships, and effective interventions. Addressing the identified low awareness levels through targeted education campaigns aimed at healthcare professionals and the public is essential.

Despite these methodological limitations, this study significantly contributes to the understanding of VSS prevalence, symptom patterns, and associated factors in Saudi Arabia. These findings underscore crucial gaps in clinical and public awareness, highlighting the urgent need for education and research to improve the recognition, diagnosis, and management of VSS [21].

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