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Charles Bonnet Syndrome (CBS) by Kathy Aquilante, OD, PhD A sudden change in vision may be associated with visual hallucinations. About 13% of patients with macular degeneration experience visual hallucinations called Charles Bonnet Syndrome (CBS) after the man who described these hallucinations in his visually impaired grandfather in 1780. CBS is NOT a mental illness. But people who start to see things worry that something is wrong with their minds. They may keep the experience to themselves for fear that people will think they are losing their minds. Friends and family members should understand that CBS is a normal occurrence in many visually-impaired people. These visual hallucinations take all kinds of forms and can be enjoyable or upsetting. In general there seem to be two different kinds of things that people see. The images can be black and white or in color, can involve movement or stay still, and they can seem real, such as cows in a field, or unreal, such as pictures of dragons. The two types of hallucinations are: 1. Patterns and lines, which can become quite complicated like brickwork, mosaic or tiles. 2. Complicated pictures of people or places. Whole scenes, such as landscapes or groups of people can appear. These may be life size or tiny people and tiny things. These pictures appear suddenly and can continue for minutes or sometimes several hours. Many people describe images that reappear with each hallucination such as distorted faces or the same tiny people in particular costumes.

The hallucinations seem to happen when there is not much else going on, for example when people are sitting alone, or when they are in lying in bed at night. The images may stop if the person experiencing them changes position (for example, if you are sitting down and then stand up), or if something in the environment changes (for example, if you are in the dark and then switch a light on). The cause of CBS is still not well understood. One theory suggests that because the brain is not receiving visual images as it did prior to vision loss that new fantasy pictures, or old pictures stored in our brains, are released and experienced as though they are seen. At this time there is no cure for CBS. Sometimes just knowing that it is poor vision and not mental illness causing these hallucinations helps people come to terms with them. CBS may disappear after about a year or eighteen months but this will not happen for everyone with the condition. If the hallucinations are upsetting, the following are some of the treatments that may help people with CBS: Treatment of the vision disorder(s) Treatment of any psychiatric problems, especially depression Grief counseling Increasing social stimulation People who become visually impaired suddenly should be aware of Charles Bonnet Syndrome so that they can discuss their experiences openly with friends and family members. Patients should alert their physicians in order to rule out factors that could contribute to the hallucinations such as side effects from medications.

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Microsoft Word - Charles Bonnet Syndrome-web.doc