Source: Healio Interviews
Disclosures: Shepherd reports no relevant financial disclosures.
March 24, 2021
2 min read

Q&A: Visual hallucinations may have worsened during pandemic

Source: Healio Interviews
Disclosures: Shepherd reports no relevant financial disclosures.
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The COVID-19 pandemic may have exacerbated Charles Bonnet syndrome in some patients with low vision who experience visual hallucinations, according to a study.

The study, published in BMJ Open Ophthalmology, surveyed 45 patients with active Charles Bonnet syndrome over a 31-day period. The mean age of respondents was 69.3 years, and 42.2% had macular disease. About half of the respondents reported an exacerbation of visual hallucinations during the pandemic.

Healio/OSN spoke with John D. Shepherd, MD, about the research and ways he connects with patients who might be experiencing visual hallucinations.

Healio/OSN: What is Charles Bonnet syndrome?

Shepherd: With visual impairment, there is this interesting phenomenon in which people can see things in their vision that are not really there. These can be shapes, colors or patterns, or they can be complex things such as buildings, animals or people. People can experience such hallucinations with any cause of visual impairment, but especially with retinal disease and macular degeneration. The key thing is that individuals have insight into the unreality of their visual experiences. The hallucinations may be enjoyable or annoying, but it can be frightening if they do not understand why it is happening.

Healio/OSN: What are your thoughts on the study evaluating Charles Bonnet syndrome during the pandemic?

Shepherd: The findings are quite interesting even though the study has limitations. One of the things known about Charles Bonnet syndrome is that stress, anxiety and social isolation can increase the chances of having these hallucinations, so it is not surprising that in this study individuals noticed worsening symptoms associated with the consequences of the pandemic restrictions. I have not noticed this in my own practice, but I have not asked my patients specifically if they have had an exacerbation of their hallucinations.

Healio/OSN: Is there anything that can be done to alleviate these hallucinations?

Shepherd: There are several things that may be tried. If the hallucinations occur in dim light, then try turning on the lights or opening the curtains. If they happen in a quiet setting, then try turning on the TV or radio or talking with someone on the phone. Closing the eyes and then moving the eyes may be helpful. Minimizing anxiety and stress may be helpful through means such as exercise and getting enough rest.

Healio/OSN: What kind of diseases may be associated with Charles Bonnet syndrome?

Shepherd: I have seen it most commonly with retinal diseases, especially macular degeneration, but it can occur with almost any cause of visual impairment such as optic neuropathy, diabetic retinopathy or glaucoma.

Healio/OSN: Do you have anything else to add?

Shepherd: Where most ophthalmologists fall short is that they do not take the time to ask the patient with visual impairment if they are seeing things in their vision that they know are not there. Patients do not understand why they are experiencing visual hallucinations, and if they receive reassurance about what is going on and that the hallucinations are from their eye disease and not a mental illness, it can greatly minimize anxiety.