Awareness of Charles Bonnet syndrome among ophthalmologists: a survey study

Charles Bonnet Syndrome (CBS) is a condition characterized by complex visual hallucinations in individuals with significant visual impairment. Despite its prevalence, CBS remains under-recognized, leading to delayed diagnoses and unnecessary distress for patients and their families. Awareness among ophthalmologists is critical for early identification and management. This study aims to evaluate the awareness and understanding of CBS among ophthalmologists and identify gaps in knowledge, diagnosis, and management practices.

A cross-sectional survey of 322 ophthalmologists was conducted using the SurveyMonkey® platform. The survey assessed demographic characteristics, awareness, and CBS diagnosis and management approaches. Statistical analyses included the Chi-square and Bonferroni methods.

While 63.9% of ophthalmologists surveyed were aware of CBS, only 21% of them were able to accurately answer all four questions (questions 8-11) regarding the definition of CBS, the vision levels at which it can be observed, the types of hallucinations it involves, and the ocular diseases in which it may occur. In addition, 66% of the participants had not encountered a CBS case in the past year. Awareness was significantly lower among those with ≤ 5 years of experience (33.3%) compared to those with ≥ 6 years (p < 0.001). General ophthalmologists demonstrated lower awareness (53.2%) than specialists in posterior segment disorders and uveitis (77.2%). Only 16.1% routinely enquired about symptoms of CBS. Most ophthalmologists prefer to refer patients to other specialties rather than manage cases themselves.

Ophthalmologists' limited awareness of CBS and their failure to question symptoms in patients with low vision may lead to underdiagnosis of these patients. Comprehensive education programs, awareness campaigns, and clinical guidelines are necessary to improve outcomes for patients with CBS.