Visual Snow Syndrome – POTS – Ehlers-Danlos Post-Concussion – Long COVID
Frequently Asked Questions
How long is the evaluation?
The exam is typically broken up into segments of 45-90 minutes each over the course of two to three days due to the extensive amount of testing, time, and the possibility of provoking symptoms. The evaluation usually consists of a more brief initial visit on day one followed by additional diagnostic testing at a future visit(s). Depending on a patient’s unique condition and findings during the initial visit, the amount of follow-up testing can vary from patient to patient.
What does the evaluation include?
It can include the following, as determined necessary by Dr. DeStefano:
Comprehensive eye exam – If you have had your eyes dilated within the past year, please bring records, and dilation may be skipped if results were normal. Otherwise, recommendations will be made to receive a dilated examination—either by Dr. DeStefano or by another eye care provider in your area, if you are in town from another state. Retinal photography is offered to patients who decline dilation. Several tests of eye tracking, alignment, and focusing not normally performed during a routine eye exam are also performed in this exam.
Computerized infrared eye-tracking assessment (RightEye) – The computer uses an infrared camera to track your eye movements while you read, follow a moving target, and look from one place to the next. It then graphs out your exact eye movements with tracings on a graph and plays them back; these measurements will be compared to normative values so that you can be given a “score.”
Trialing of sample lens tints – We have samples of specially chosen lens colors to look through. The patient can observe what effect there is on his or her visual snow, light sensitivity, sensitivity to patterns, dizziness, headache, anxiety, etc. if these symptoms are present. The patient can look at the plain wall, read, go outside, and adjust the lights–whatever he or she needs to do to know what helps and to what extent.
Use of the Cerium Intuitive Colorimeter – This is an instrument for determining the potential of almost any color of light to improve symptoms. The patient looks into an aperture on the device, viewing a white piece of paper with black letters on it, with light shining on the paper. The patient or doctor adjusts the color of the light with a wheel that can select from 360 different hues and 50 different levels of saturation—for a total of 18,000 possible combinations. If any color within the device causes an improvement in symptoms (difficulty focusing, afterimages, words shaking, static, depersonalization, etc.) it can be made into a custom lens tint for glasses.
Motion sensitivity assessment – The patient is asked to perform a series of visual tasks involving motion and then rate each task’s associated level of discomfort. The tasks are then repeated with different lenses, prisms, filters, etc. to see which lenses the doctor can utilize to produce an immediate reduction in sensitivity to the same tasks.
Syntonics (light therapy) trial – The patient looks at a lamp projecting a light of a very specific color and brightness OR wears glasses containing the colored filter while viewing a light source (either sunlight from a window or a full-spectrum lamp).
Different colors are tested for a few minutes at a time to assess effects on symptoms such as visual disturbances, headache, dizziness, anxiety, etc.
Trialing of Irlen filters – These are colored overlays that can be placed on paper or electronic reading material. They come in ten different colors. They will be placed over various reading materials to ascertain whether any particular color makes reading tasks more comfortable. If the effect is significant and the patient would like an Irlen filter, he or she can purchase one.
How much will the evaluation cost?
Cost will vary from person to person, as some charges are time-dependent, and some tests may not be needed with certain patients. Some patients, depending on their unique symptoms and level of severity, will require more or less testing than others. The office staff will submit to your medical insurance (which may or may not reimburse for the visits), but payment is expected in full for each visit at time of service.
What does treatment entail?
Treatment can involve one or more of three modalities:
Therapeutic glasses — If a patient responds positively to any lens, prism, and/or tint interventions tested in the office, then I may prescribe glasses to help treat the condition and its associated symptoms. Lenses do more than make things clear or blurry–they affect our eyes’ ability to focus/work together, our brains’ capacity to process visual information, and our awareness of
Syntonics — This is the light therapy mentioned before. If a patient benefits more from a colored lamp than from colored glasses and a light source, then we can have a lamp made and sent to the patient. If the patient benefits more from the colored glasses, then he or she may leave with a pair.
Neuro-optometric rehabilitation therapy — Neuro-optometric rehabilitation therapy (also known as vision therapy) is aimed at addressing symptoms associated with visual snow, POTS, post-concussion syndrome, etc. such as headaches, eyestrain, double vision, difficulty focusing, motion sensitivity, lack of spatial awareness, difficulties with reading or driving, and more.
It is an individualized therapy program designed to enhance or develop various aspects of eye movements, focusing, spatial awareness, processing of motion, and cognitive aspects of vision. It involves a structured set of exercises given to a patient in one-on-one sessions either in the office or, when unable to do in-office therapy, via a remote program like Zoom or Google Meet (if the patient is a candidate for this mode of therapy). Generally, the highest quality of therapy is done in a physical office, but for some cases, remote sessions can be just as effective; the key is knowledge of the patient’s condition and how to approach it.
For further questions, you may reach Dr. DeStefano at drdestefano@visualsymptomstc.com