Interim results of the mbct-vision study show improvement of visual snow syndrome (VSS) in the first treatment trial for vss

Background: Visual Snow Syndrome (VSS) is a condition of persistent flickering dots in the visual field Functional imaging shows neuronal dysregulation To date, no treatment trials in VSS have been published Functional imaging in persistent photophobia despite treatment of identifiable ocular causes, also shows neuronal dysregulation Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based clinical intervention to develop skills of mindfulness and cognitive behavioural therapy (CBT) strategies, through eight weekly small-group sessions and structured daily practice MBCT studies have shown neural changes correlated with psychological wellbeing We hypothesized that MBCT, modified to incorporate aspects relevant to persistent distressing visual symptoms, can improve symptoms by modulating dysfunctional neural pathways, training attention, and developing psychological resilience to cope with symptoms Objective: To assess the feasibility of modifying MBCT for visual symptoms (MBCT-vision), to treat VSS and/or persistent photophobia Method: Prospective cohort open-label 8-week MBCTvision treatment trial Quantitative (baseline, week-9, week-20): changes in self-rated 10-point-scale of symptom severity, impact on daily life, World Health Organisation Wellbeing index (WHO-Wellbeing), CORE-10 psychological distress scale, Five Facet Mindfulness Questionnaire (FFMQ) Qualitative: thematic analysis of focus-group (week-9) and questionnaire (baseline, week-9, week-20) using the Framework approach Results: Jan-May2020: Seven participants (6 VSS, 1 photophobia) completed the study, one (VSS) dropped out due to work Self-rated symptom severity improved: baseline (mean 6 33, SD 1 75) to week-9 (mean 5 83,SD 2 14, p=0 45) and week-20 (mean 3 33, SD 2 16, p=0 01) Impact of symptoms improved: baseline (mean 5 5, SD 2 17) to week-9 (mean 3 67, SD 1 21, p=0 14) and week-20 (mean 1 67, SD 1 63, p=0 028) No statistically-significant change of WHO-wellbeing, CORE-10 and FFMQ scores between baseline, week-9, week-20 There were trends of improvements in FFMQ, specifically in three domains ('observing', 'acting-in-awareness', 'non-reactivity'), but did not reach statistical-significance Thematic analysis: improved symptoms and reduced distress associated with ability to modulate attention, emotion and response to residual symptoms Interpretation: MBCT-vision significantly improves severity and daily impact of visual symptoms at 3-months The trends of improvements in some mindfulness domains are of interest The overall wellbeing and mindfulness scores may have been affected by the COVID19 pandemic The visual improvement at 3-months compared to immediately following completion of MBCT-vision study suggests a longer period of regular mindfulness practice is needed to change neuronal pathways for symptom improvement Future studies planned to include functional imaging will further elucidate this