Charles Bonnet syndrome in practice

Charles Bonnet syndrome in practice


Charles Bonnet syndrome is a condition characterized by complex visual
hallucinations and I’ll explain that in a moment alongside deteriorating vision due to
ocular disease in the absence of any other psychiatric and neurological disorders but with
preserved insight, and what preserve inside means is that the patient’s know these things are not real. How do we know
that our patients visual hallucinations are
Charles Bonnet particularly with so many of our
visually impaired patients being older than and they will have other comorbidities as well as how do you know and as optometrist we probably aren’t in
the place to give the diagnosis of Charles Bonnet syndrome
but we can help along help by taking the complete history to rule out causes and then perhaps safely reassure the patient that
perhaps this probably is Charles Bonnet and maybe may be referred to the GP for confirmation of that. What causes Charles Bonnet syndrome it’s basically lack of sensory input because not enough sensory input is
going to the right place the surrounding areas of the brain where
the input this suppost to be going said have tried compensate by becoming hyper excited
this is what frequency MRI studies show if the patient with visual impairment
is showing is exhibiting Charles Bonnet
syndrome that’s a good thing that shows the brain
is very plastic it’s trying to
adapt to the vision loss see you can present it in a positive way
to your patients how common is it it’s fairly common
almost in quarter to a third about patient with
visual impairment do suffer from charles Bonnet syndrome who’s affected by this what are the
associated risk factors I’m sure we all know, its age. But this could
be because visual impairment is high in older
people gender it seems to reported to be
slightly higher in females again this could be because women live
longer than men Ocular factors, well it’s more common
in bilateral visual impairment but it is reported in patients who had
one eye enucleated at what and where the other eye is intact and
those with monocular vision loss due to other reasons it has been reported it’s just more common that
people with bilateral vision impairment and is also more common in central visual impairment but again not uncommon in people with visual field defects such
as somebody with hemionopia or glaucomatous
visual field loss What is the impact of Charles Bonnet?
until recently we thought this was a benign condition
patient knows it’s not real you just need to give them a pat on the back and
say that it’s gonna be fine its not real but recent paper in the British journal
of ophthalmology it was published in May this year by Dominic Ffytche and his colleagues it looked at the
emotional aspects surrounding Charles Bonnet syndrome which gives a different picture of what
patients might be going through one of the questions that ask his how do
you feel when you first experience Charles Bonnet syndrome 12
percent said they were amused 14 were indifferent 20 said they were
intrigued and 10 percent to the curious however
quarter of them, 25 percent were startled by it 15 percent said they were frightened and
4 percent which is small but not insignificant said they were terrified so just under
half of them had some sort of negative emotional
response to Charles Bonnet syndrome so we do need to be aware of what
patient might be going through and do something about helping them how long
does it continue again until recently we thought it
happens for 12 to 18 months and then it’ll go away this is the advise we were giving up to
our patients but the study was done to macular disease society the large cohort of patients and 75
percent to the said they was still getting Charles Bonnet
syndrome five years and on so you know it’s not a problem
that’s gonna go away people need to learn to adjust to it we
as eye care professionals need to help that along what types of images are seeing I think
that can be important because if the image is a scary gonna be have
more the negative impact on patient and they can see all sorts things that
people and figures and faces the faces are described as grotesque
it’s something you come across for the first time we can be very scary animals if you’ve got a phobia of an
animal like a spider or a snake you’re going to overreact and
landscapes which if you see a beautiful scene you might
be happy but if you think you are hanging off a cliff then you’re not going to be happy so I
think the the type to the images you the patient’s may experience will have an effect on how
they feel about it things that patience said that make that Charles Bonnet syndrome worse they seem to be worse at night and in
the evenings and worse if the light is poor in
contrast those who’ve been very very bright light said
they also experience Charles Bonnet syndrome after it and being inactive being
sedentary being alone is a factor that makes
things worse tiredness fatigue nervousness and stress also
increases these symptoms what’s gonna help disable the symptomatology putting on a light if
it’s dim or dark looking away and distracting yourself
seems to help blinking a lot will help approaching the
hallucinations and shouting and talking to them
particularly if they are people how can you help our patients making
patients aware and making health professionals or
carers around the patient’s aware that such a
thing exists and normalizing it as part of visual impairment will help and reassuring them as
optometrists maximizing their residual visual field reduce sensory deprivation and isolation counseling at other psychological
therapies particularly for patients disturbed by them some papers have
talked about psychotherapy techniques helping the patience come to
terms with it they don’t go away but they come to
terms and that they don’t bother them as as much so what should we be doing as optometrists I think we should be asking
all our patients who have some sort of visual impairment if they see it because they will not volunteer this
information freely especially if they’re afraid they’re going to be labeled as being mad and if they do on up to it
reassure them this is a normal part visual impairment
informed the GP to make the formal diagnosis more importantly we can maximise their residual vision. Make sure that they’re wearing the correct refraction provide any low vision aids
that will keep the more active but also in Leicester we have
a very good organization for the visually impaired
call Vista which runs befriending service so if you
have something like that you could to refer your patience particularly
their living alone you think they are isolated and lonely you refer
them to their local Society for the Blind refer
for formal counciling if you think patients very emotionally disturbed by
this I would I would do this through GP though I wouldn’t leave
the GP out of the loop

5 comments / Add your comment below

  1. thanx for the video man. i was diagnosed with stargards when i was 9 years old and i had my first experions when i was @t i have so much to tell you i now alusenate al the time it never go away not evn when i close my eyes only found out that im not alone a vew days ago im 29 so for almost 20years i had scary funny and just playn weerd times it gose way deeper then alot of ppl @t self also freekt out ass a kid .thank you for teling ppl about this i have been looking for awnsers for a long time and now i can tell ppl aswel im not crazy aferal lol

  2. The GP''s don't want any part in evaluating this syndrome or exploring other causes. Specialists are the current go to people and it is exhausting having to wait weeks or months to get in to see them while a loved one is equally exhausted dealing with this syndrome. Add insurance red tape on top of that and the vicious circle of trying to seek help continues.

  3. With my mother in law we have identified with two unrelated hospital stay found when she had oxygen and IV fluids her visions stopped. Once she was off of them, everything slowly (day or so) came back. Trying to get them to prescribe this (oxygen/fluid) for her but it's a struggle. Seriously she's going to lose her mind shortly if we don't find something to reduce the visions. Frankly she's been dealing with this for over 10 years with visions never stopping. Constant. Seriously? should tell them to ignore? She sees snakes and people. She has absolutely no dimentia. She has a brilliant mind…these things just are "added" to her world. We tell her to touch the things she is seeing to get herself straight again. But how do you deal with constant visions?? She can control it less and less every day.

  4. My mom was diagnosed 2 weeks ago, since then my dads health has gone downhill and he only has a few days left probably, I think the stress of him making this transition has made her visions worse, this morning I get to the house and all the doors are blocked by furniture in the inside, she had not told me her visions had gotten that bad that quick, last I heard she was at the most seeing crows in the room. Last night there were ‘people’ in her house.

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