Prevalence and characteristics of visual snow syndrome in Saudi Arabia: a survey-based analysis

Abstract Background Recognition of visual snow (VS) and visual snow syndrome (VSS) is growing. It is a form of visual hallucination characterized by the perception of small, bilateral, simultaneous, diffuse, mobile, asynchronous dots usually throughout the entire visual field, but sometimes occurring partially. It is characterized by persistent visual disturbances, including photophobia, palinopsia, and nyctalopia, as well as non-visual associations like migraine, tinnitus, and psychological distress, for which there is currently little therapy. It is not yet known how common they are globally. This study aims to estimate the prevalence of VSS among responders in Saudi Arabia and identify its associated risk factors and clinical characteristics. Methods Using a standardized, self-administered questionnaire distributed via social media, this cross-sectional study was conducted across several areas of Saudi Arabia from June 1st to August 2nd, 2025. Adults (≥ 18 years) who have consented to participate were included. Fisher’s exact test, one-sample proportion test, Firth’s penalized logistic regression, and descriptive statistics were used to analyze the data, with significance set at a p-value less than 0.05. The sample size was determined using an anticipated VSS prevalence of 2.2%. Results A total of 711 participants were included. The overall prevalence of confirmed VSS was 1.7% (95% CI, 0.9%–3.0%). Participants with confirmed VSS had significantly higher rates of tinnitus (91.7%), migraine (50.0%), and tension headache (33.3%). Logistic regression analysis indicated that tinnitus was an independent predictor of VSS in our sample (OR = 4.91, 95% CI, 1.12–45.7, p = 0.033). The most common symptoms among VSS participants included photophobia (100%), visual sparks (91.7%), and floaters (83.3%). Conclusion In Saudi Arabia, VSS prevalence is around 1.7%. However, there is a low incidence of identification and therapy since affected people have a restricted tendency to seek medical assistance.