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  • Charles Bonnet syndrome appears underreported in patients with AMD

    Retina/Vitreous

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    Review of: Associations between age-related eye diseases and Charles Bonnet syndrome in participants of the Age-Related Eye Disease Study 2: report number 26

    Le J, Peprah D, Agrón E, et al. Ophthalmology, in press

    Ten-year follow-up data from the Age-Related Eye Disease Study 2 (AREDS2) were reviewed for prevalence of visual hallucination and other symptoms characteristic of Charles Bonnet syndrome (CBS) in older patients with AMD.

    Study design

    In this report, the investigators described their use of 10-year AREDS2 data to review the prevalence and characteristics of CBS among older participants (mean age of 72.6 years).Associations between recording CBS-related symptoms and the conditions of late AMD and cataract surgery were also investigated.

    Outcomes

    Certified interviewers evaluated study participants for CBS symptoms at both the end of the regular trial period and after the 10-year follow-up period. Of the 3651 study participants, 87% responded to CBS-related questions at least once during the follow-up period; of that group, 12% had self-reported CBS symptoms, including visual hallucinations. Within the group, 86% had late AMD and 64% had prior cataract surgery in one or both eyes; 68% had best-corrected visual acuity of <20/40 in the worse eye at the end of the trial. Both late AMD (odds ratio [OR] 1.95 by 10 years) and previous cataract surgery (OR 1.42 by 10 years) were associated with reporting CBS symptoms. Reporting CBS symptoms was also associated with having depressive symptoms (OR 1.51).

    Limitations

    The survey nature of the data collection may have introduced reporting bias, as not all patients may have wanted to disclose the presence of visual hallucinations. The investigators were not able to fully discount the possibility of other causes of hallucinations in patients who do not have visual impairment.

    Clinical significance

    This is one of the larger studies to identify the extent of the development of CBS in older individuals with AMD. The study findings should prompt ophthalmologists to be more vigilant in their detection and management of CBS, which can be functionally disabling.