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The Phantom Images of Charles Bonnet Syndrome

“Do you ever see something you know is not there, but it looks real?” This is a question I always ask my low-vision patients, to determine if they are experiencing Charles Bonnet Syndrome.

Some respond that they see purple flowers everywhere, even in winter. Others see geometric, quilt-like patterns or animals, people or buildings. They rarely share their experience with their families, for fear of being misunderstood. Some wonder themselves whether the visions suggest early dementia.

In 1789 Swiss naturalist Charles Bonnet described the visions of his father-in-law, who had low vision and saw people, animals and other objects that he knew were not real. Bonnet himself experienced phantom visions later in life, similar to those of his father-in-law. Bonnet’s discovery went largely unnoticed for 150 years until the 1930s, when doctors rediscovered his files and named the syndrome after him.

Charles Bonnet Syndrome is very common, affecting 20 – 30 percent of those with low vision. Some experience it for a few months, others for several years. Images can occur daily or only occasionally and the same image appears to the same person. Although there is no cure, seeing the images does not bother most people and many find them interesting or amusing, especially once they understand that it is just their eyes playing tricks on them.

Although the cause is not known, the images are believed to be like the “phantom pain” that people who have had a limb amputated can experience. The nerves that were connected to the missing limb still send signals to the brain. In our visual system, the nerves that do not receive their usual visual messages fire off independently and the brain “sees” images that appear real, but recognizes they are not.

Many physicians are not yet aware of Charles Bonnet Syndrome and may mistake it for hallucinations that occur in individuals with normal vision for other reasons.

It is important to identify Charles Bonnet Syndrome, with these criteria:

  1. The person has low vision.
  2. The images occur when the person is conscious, with open eyes.
  3. The person recognizes the images are not real.
  4. The same image appears repeatedly, superimposed on the real world. For example, you see the room as it is, but the wall may appear to have flowers on it.
  5. Images are only visual; they may move, but there are no sounds, or smells. It’s like seeing a picture or watching a silent movie.
  6. Images are common, familiar objects. They may be amusing or mildly annoying, but not frightening.

If you or someone you know has low vision and may be experiencing Charles Bonnet Syndrome, discuss it with an ophthalmologist.

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