Charles Bonnet syndrome
Robert Yacoub1, Steven Ferrucci
1Southern California College of Optometry, Fullerton, California, USA.
Insights
Charles Bonnet syndrome (CBS) causes visual hallucinations in individuals with severe vision loss. Early identification and management of ocular conditions are key to addressing CBS symptoms.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Charles Bonnet syndrome (CBS) is characterized by visual hallucinations in individuals with significant visual impairment.
- Patients often have ocular diseases like macular degeneration or diabetic retinopathy, leading to reduced vision.
- Fear of mental illness diagnosis makes patients hesitant to report these hallucinations.
Observation:
- Presents three cases of Charles Bonnet syndrome (CBS) attributed to decreased vision.
- Patients experienced visual hallucinations consistent with CBS.
- One patient underwent MRI and psychological evaluation, confirming the diagnosis; two others received presumptive diagnoses due to testing refusal.
Findings:
- The presented cases highlight the occurrence of CBS in patients with diminished visual acuity.
- Diagnostic confirmation was achieved in one case through neuroimaging and psychological assessment.
- Presumptive diagnoses were made in other cases based on clinical presentation.
Implications:
- Management strategies include treating the underlying ocular disease and optimizing vision with low vision aids.
- The aging population will likely lead to an increase in CBS cases.
- Primary care optometrists must be familiar with CBS for accurate identification and patient support.
Background:
Charles Bonnet syndrome (CBS) involves nonthreatening hallucinations in patients who have no neurological and no psychological abnormalities but with significant visual impairment secondary to ocular disease, such as macular degeneration and diabetic retinopathy. Because of the fear of a mental illness being diagnosed, patients are often reluctant to discuss these hallucinations.
Case Reports:
Three cases are presented of patients who experienced CBS caused by decreased vision. Each patient had decreased vision and related visual hallucinations that were consistent with CBS. The first patient underwent magnetic resonance imaging and psychological evaluation, which confirmed our suspicion. The other 2 patents were not willing to undergo further testing, so our diagnosis is presumptive.
Conclusion:
Management for these hallucinations includes treatment of the actual ocular disease as well as optimizing vision for the patient using appropriate low vision devices. As the population continues to age, more patients will be seen with reduced vision caused by a myriad of ocular diseases, increasing the likelihood that more patients may present with CBS in the future. It is therefore prudent to become familiar with the syndrome so primary care optometrists can properly identify CBS and help their patients deal with it.
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