Any eye condition, including age-related macular degeneration (AMD) that results in vision loss can lead to a person experiencing visual hallucinations. Wet age-related macular degeneration causes significant vision loss due to the leaking of plasma and blood from abnormal blood vessels in the back of the eye, resulting in permanent macular damage.

Visual hallucinations that appear as a result of vision loss are also known as Charles Bonnet syndrome (CBS), and are an infrequent, yet sometimes disabling, symptom of wet AMD that occurs in some patients. These hallucinations, which result from vision loss and not due to mental illness, can be highly disconcerting and even frightening when they first appear.

These hallucinations have no known cure or single treatment. However, by understanding what causes them, you’ll be able to reduce your anxiety when they occur — and establish techniques to get through them with minimal discomfort.

What is Charles Bonnet Syndrome?

Charles Bonnet syndrome (CBS) affects some patients with low vision caused by a variety of eye diseases. Patterns, as well as more complex pictures such as people, animals, flowers, and buildings, can appear in these hallucinations.

If you lose vision from any eye condition, including age-related macular degeneration, glaucoma, or diabetic retinopathy, the eyes no longer send signals to the brain as before. Without visual signals arriving at the brain, the brain then fills the void by recalling images from memory, resulting in the visual hallucinations of CBS.

CBS is named after Charles Bonnet, an 18th-century Swiss scientist who first identified this condition in his grandfather and then developed it himself.

What Do Visual Hallucinations Look Like?

Charles Bonnet hallucinations may appear as simple unformed flashes of light, colors or shapes.

However, many people envision more complex structures, such as geometrical grids and lattices.

Landscaped gardens or views, animals, people and a procession of small costumed characters wearing hats have also been reported by CBS patients, according to the Macular Society. The hallucinations are frequently depicted in greater detail than they would if they were real.

Some people find their hallucinations enjoyable. Others find them an unwelcome inconvenience, especially if they temporarily obstruct vision.

When Do Visual Hallucinations Occur?

CBS hallucinations come and go without warning, typically spanning months or years, with no apparent reason and no connection to cognitive or psychiatric disease.

The syndrome’s prevalence in patients with visual impairment varies from 10% to 15%, but it can can also affect patients with other macular diseases, ocular conditions including glaucoma, and stroke.

CBS is more frequent in people over the age of 80, but it can affect anyone at any age. CBS does not necessarily indicate that an individual’s vision is deteriorating, and people can have visual hallucinations even if they just have minor vision loss or small blind spots.

What Causes CBS?

Exactly what causes visual hallucinations is unknown, but researchers believe that deafferentation (the interruption or destruction of nerve cells) leads to the loss of signals from the eye to the brain. MRI investigations show that these visual signals ordinarily inhibit some nerve activity in the brain and when the signals are missing, there is more spontaneous nerve activity, which is perceived as hallucinations.

How to Manage Visual Hallucinations

Eye movements appear to reduce the severity and duration of hallucinations. Even if individuals have limited remaining vision, eye movements engage visual areas of the brain in people with macular degeneration. Certain types of hallucinations, notably patterns and colors, may be stopped by these motions.

Dr. Dominic ffytche at King’s College, London, recommends that patients consciously move their eyes when experiencing a hallucination.

Try the following exercise:

• Imagine two locations on a wall in front of you that are about 3 feet apart to the left and right. For 15–30 seconds, stand approximately 3.5 feet away and glance from one place to the other once every second or faster. When looking left and right, don’t move your head and keep your eyes open. Allow yourself a brief break.
• Try repeating the exercise if your hallucinations are still there.

The technique is unlikely to work if the hallucinations have not stopped after four or five attempts. However, you might want to try again later.

Other ways to stop a hallucination:

• Look away from the image towards an object on the side of your vision or shut your eyes
• Turn on the lights in the room or, if you’re in a brightly lighted place, go somewhere darker.
• Get up and engage in an activity.

If you have wet AMD and are experiencing visual hallucinations, contact Kissel Eye Care Low Vision Center. We can help you manage your AMD.

Kissel Eye Care Low Vision Center serves patients from Lititz, Lancaster County, Elizabeth Township, and East Petersburg, Pennsylvania and surrounding communities.

Q: Are there risk factors to CBS?

• A: Yes. Individuals with vision loss who are over 80, live in isolation or in dark environments are at a higher risk of experiencing visual hallucinations.

Q: Can other conditions cause visual hallucinations?

• A: Other disorders that might cause visual hallucinations include psychiatric diseases and neurologic conditions like Parkinson’s disease and Alzheimer’s disease. Visual hallucinations can be also caused by a variety of prescription and illegal substances, as well as withdrawal from drugs or alcohol. Tell your eye doctor if you are experiencing hallucinations.

For people with low vision, reading can feel like running a marathon. Many stop reading altogether because what used to be enjoyable and effortless now requires effort and adjustment to using peripheral vision.

Fortunately, there are many low vision devices that can make reading easier and more rewarding for people with glaucoma, retinitis pigmentosa, macular degeneration and other low vision conditions.

Below is a list of low vision magnifiers, aids, devices, and strategies that can help people with low vision read more easily and comfortably.

Low Vision Devices for Reading

Reading Magnifier

The most commonly used visual aid for reading is a hand-held magnifier.

Magnifiers with the appropriate power enable people with low vision to read the text of medicine bottles, food labels and oven dials, among other things. Magnifiers come in a variety of sizes and shapes, including compact pocket magnifiers, full-page illuminated magnifiers, and magnifiers with adjustable supports.

Magnifiers are not well suited for continuous reading, like books or newspapers. They work well for spot reading, like labels, dials and medicine bottles. In general, the larger the magnifier, the less powerful it is. Also, the power markings on the magnifier are not standardized, so two magnifiers both marked “3x” are probably not the same.

It is best to have your low vision optometrist recommend the right magnifier for your needs.

Video Magnifier

While traditional optical magnifiers are generally helpful, some people benefit more from a video magnifier.

A video magnifier, also known as closed-circuit television (CCTV), is a device that uses a camera to send magnified images (up to 50x or greater) to a large desk monitor or television screen.

Video magnifiers have many advantages over optical magnifiers in that they have variable magnification and can improve contrast. However, they are not as convenient as optical devices and are much more expensive.

Portable Electronic Magnifiers

A portable electronic magnifier resembles a tablet or iPad. When holding it in front of your reading material you can see the magnified version of the text on the device’s LED screen.

High-Power Reading Glasses

A person with significant visual impairment may be able to use strong magnifying reading glasses to view fine print. These eyeglasses magnify the print size to allow easier reading.

Strong reading glasses or “microscope” glasses are more convenient for continuous reading, like newspapers and books.

Microscope reading glasses require a closer reading distance which does take some adapting. However, they allow much greater comfort and speed when reading for enjoyment.

Tele-Microscopic Glasses

Tele-microscopic lenses are prescription lenses that are installed in a telescope-like device and placed on top of the glasses. They can be prescribed for one or both eyes and enable a person with low vision to read, write, use a computer, and accomplish other activities from a comfortable distance.

Certain low vision devices are custom-made for a patient’s specific needs. A prescription from your eye doctor may be required.

Tele-microscope glasses, or “reading telescopes” afford a much greater reading distance, which some find more comfortable. They are a bit heavier than microscope glasses but are much more versatile in their use.

More strategies to help your reading

Increase Contrast

When reading, it’s best to have a sharp contrast between the text and its background. Newspapers, for example, don’t have much contrast because the grey characters are set against an off-white background.

Many electronic screens allow users to adjust the contrast according to their preferences, such as black lettering on a yellow background or black lettering against a white background.

Increase Lighting

Increasing the amount of lighting and choosing the appropriate lighting for the setting can considerably improve reading ability and boost comfort. For example:

Direct light – Using an adjustable gooseneck lamp that allows you to focus the light directly onto the reading material can be helpful. We recommend “gooseneck” with lower strength bulbs for better lighting and less heat.

Sunlight – Sitting near a window to get natural sunlight while reading a book or other written text is ideal.

Large-Print Books or Larger Fonts

Large-print books include larger fonts, better contrast and more spacing, making it easier and more enjoyable to read.

Adjust Settings on Your Smartphone

Smartphones feature special settings for people with low vision. These features are wide-ranging and include the ability to select larger lettering to SMS messaging that the phone can read out loud.

Coping with low vision isn’t simple. However, developing your own life hacks and methods can make reading easier. Take your time to find what works best for you. Eventually, you’ll find the best solutions for your specific needs.

Contact Kissel Eye Care Low Vision Center to find out which low vision aids and devices are right for you.

Q: What is a low vision exam?

• A: A low vision exam includes components that are not usually part of a standard eye exam. Dr. Nachtigall will analyze the nature of your vision loss after testing your visual acuity. This will aid the doctor in determining how low vision is affecting you and your ability to perform day-to-day activities. Dr. Nachtigall will then describe how certain low vision glasses and various low vision aides can help you regain as much daily function as possible.

Q: Does low vision mean blindness?

• A: No. Low vision is vision loss that can’t be corrected with glasses, contact lenses or surgery. However, it’s not considered blindness, as some sight remains. This allows a person to still use the sight available and benefit from various low vision devices.

Kissel Eye Care Low Vision Center serves patients from Lititz, Lancaster County, Elizabeth Township, and East Petersburg, all throughout Pennsylvania.

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Low vision doesn’t mean blindness. It simply means that a portion of your vision is impaired and that assistive devices can help you continue to enjoy life.

What is Low Vision?

Hearing the terms ‘visual impairment,’ ‘low vision,’ or ‘blindness’ from your eye doctor can be confusing. The more you understand these terms, the more you’ll be able to advocate for yourself or a loved one with vision loss.

Visual impairment is a broad term that refers to any loss of vision. The following are some of the terms used to characterize different types of vision impairment:

Low vision is defined as a visual acuity of 20/70 or less in the better-seeing eye that cannot be corrected with glasses or contacts.

Legally blind is corrected vision of 20/200 in the better-seeing eye, even with glasses, contacts, or surgery. If visual aids such as eyeglasses can correct a person’s eyesight to 20/200 or better, they are not considered legally blind.

Total blindness is defined as the entire loss of functional vision as a result of a genetic condition, disease, or injury.

Partial vision refers to the capacity to see only a portion of your visual field, or to have good central vision but poor peripheral vision. A brain tumor, brain injury, or an eye condition are the most common causes.

Does Low Vision Mean Blindness?

No. Vision loss that cannot be corrected with glasses, contact lenses or surgery is known as low vision. However, because some vision remains, it is not considered blindness. A person with low vision may have blurred vision, blind spots or have poor night vision.

Common types of low vision

Loss of central vision

A person’s side (peripheral) vision is mostly unaffected by the loss of central vision.

A blur or blind spot in the center of what you’re looking at occurs from a loss of central vision. This makes it difficult to read, recognize people and identify features at a distance.

However, as long as the person has adequate side vision, mobility is still possible.

Loss of peripheral (side) vision

With the loss of peripheral vision, a person’s remaining central vision often allows them to look straight ahead, read, watch TV and recognize faces.

Peripheral vision loss makes it difficult to differentiate objects on one or both sides, as well as items directly above and below eye level. Mobility is often hindered by a loss of peripheral vision.

This is referred to as tunnel vision, and can be caused by glaucoma, a brain tumor or injury.

Blurred vision

Blurred vision causes both near and far vision to be out of focus, even with the maximum possible correction using eyeglasses. Common causes of blurred vision are macular degeneration, cataracts and diabetic edema.

Reduced contrast sensitivity

People who lose their contrast sensitivity suffer from poor vision. They have the feeling that there is an overall haze that appears filmy or cloudy.

Glare/light sensitivity

When a person’s visual system is overwhelmed by normal amounts of light. Even when exposed to typical quantities of light, extreme light sensitivity can produce pain or discomfort.

Night blindness

People with night blindness find it difficult to see outside at night or in dimly lit indoor settings.

Low Vision Devices

People with low vision can often live and work independently thanks to a number of treatment options and devices that can greatly improve their quality of life.

The most commonly prescribed low vision devices and aids include:

• Handheld and stand magnifiers
• Handheld or glasses-mounted telescopes
• Electronic (video) magnification
• Glasses-mounted magnifiers
• Assistive technology – such as screen speech/readers and software enlargement programs

Large-type books, magazines, and newspapers, as well as books on tape, talking wristwatches, self-threading needles and other products can also help those with visual impairment.

Live life to the fullest. Contact Kissel Eye Care Low Vision Center to book an evaluation of your vision and recommend the right low vision device for you.

Q: What is a low vision test?

• A: A low vision test includes components that are not usually part of a standard eye test. Your vision will be evaluated to assess the nature of your vision loss after testing your visual acuity. This will aid the doctor in determining how low vision is affecting you and your ability to perform day-to-day activities.

Q: What causes low vision?

• A: Traumatic brain and eye injuries, as well as congenital vision problems and uncorrected refractive errors, are all common causes. As you age, you are more likely to develop various eye conditions, like cataracts, glaucoma and age-related macular degeneration. Left untreated, these conditions can eventually lead to low vision and eventually blindness.

Multiple sclerosis (MS) is a disease where the immune system attacks healthy nerve cells. The protective coating of these cells, known as the myelin sheath, is damaged as a result. Damage to these cells can result in long-term scarring in the brain, which can cause a variety of symptoms.

Although MS affects every person differently, the National Multiple Sclerosis Society (NMSS) warns that vision problems are often the first sign of the disease.

Vision Problems Associated with MS

Vision problems in people with MS vary significantly. They can appear and then disappear suddenly, and can impair one or both eyes. The problems may worsen before disappearing, or they may remain.

Optic neuritis

According to the Multiple Sclerosis Trust, 70% of MS patients will develop optic neuritis at some point in their lives. For some people, optic neuritis may be the first sign of MS.

The optic nerve connects the eyes to the brain. MS can break down the myelin sheath that surrounds your optic nerve, causing the inflammation of the nerve that leads to optic neuritis. This demyelination may become more extensive and chronic as MS progresses.

Optic neuritis causes blurry or cloudy vision. Mild pain or discomfort may also occur, particularly when patients move their eyes. The most noticeable visual disturbance will most likely occur in the center of your field of vision, although it may also impair your peripheral vision. Colors may appear less vibrant than usual.

Diplopia (double vision)

In healthy eyes, each eye sends identical information to the brain, which it interprets and develops into one clear 3-dimensional image. When your eyes don’t function correctly, each eye sends a different image to the brain, which the brain cannot fuse together. This causes diplopia, more commonly known as double vision.

Diplopia is a typical symptom of MS once the brainstem is affected. Cranial nerves that flow through the brainstem govern the muscles that move the eyes, so any injury to the route can cause the eyes to become uncoordinated, sending two different images to the brain.

Though advancing MS can cause permanent diplopia, it can also resolve completely and spontaneously.

Nystagmus

Nystagmus is a vision condition where the eyes make repetitive and uncontrolled movements. The movement is usually rhythmic and causes an eye jerking or jumping sensation. As a result of these eye motions, patients may feel dizzy or nauseated.

People with MS frequently have oscillopsia, or the sensation that the world is swaying from side to side or up and down.

An MS attack affecting the inner ear or the cerebellum, the brain’s coordination center, is a common cause of this type of visual impairment. It affects some people solely when they glance in a particular direction. Certain activities may aggravate the symptoms.

Nystagmus is a common MS symptom that develops over time or after a relapse.

Vision loss

The symptoms of MS tend to worsen as the disease progresses. Advanced demyelination has the potential to harm your optic nerve and other vision-related components of your body. This can have a long-term impact on vision.

Treatment options

Each type of visual disturbance has its own set of treatment options. What’s best for you is determined by your symptoms, disease severity and general physical health. The following are some of the most commonly [utilized] treatments:

Plasma Exchange – Commonly known as plasmapheresis, the procedure ‘cleanses’ a patient’s blood. It is sometimes recommended for people with some forms of multiple sclerosis to control unexpected relapses or flare-ups. Certain proteins in their plasma may be attacking their own body. When you remove the plasma, the proteins are removed, and symptoms may lessen.

Eye patch – If you have double vision, covering one eye may help you experience less nausea and dizziness.

Systemic steroids – Steroid injections may not improve eyesight long term, but they may aid in the recovery of some people who have experienced MS-related vision problems and help prevent a second occurrence. A doctor will usually provide a course of these steroids over a 1- to 5-day period. Intravenous steroids are commonly given over a 3-day period by a doctor.

Stomach irritation, mood swings, elevated heart rate and insomnia are all possible risks and side effects of steroids.

Other medications – Your doctor may try to help you deal with some of the visual disturbance’s side effects until it passes. They may, for example, prescribe Clonazepam (Klonopin) to ease the jumping or swaying sensation caused by nystagmus.

A 2017 study published in the Lancet found that over-the-counter antihistamines increased the speed of the neural signals from the eye to the back of the brain. While more research is needed, these medications may provide hope to people who have already suffered from optic nerve injury.

MS-related vision issues are common. However, not everyone is affected in the same manner. Many symptoms will resolve on their own without treatment, and the prognosis is generally favorable.

As MS progresses, however, a person’s vision problems are likely to worsen. The importance of early diagnosis and treatment in reducing symptom severity cannot be emphasized enough. If you have been diagnosed with MS, or notice any changes in your vision, schedule an appointment at Kissel Eye Care Low Vision Center.

Kissel Eye Care Low Vision Center serves patients from Lititz, Lancaster County, Elizabeth Township, and East Petersburg, Pennsylvania and surrounding communities.

 

Q: Is there a way to prevent vision disturbances caused by MS?

• A: While visual problems in MS patients aren’t preventable, there are often ways to lessen the severity of the symptoms or decrease their occurrence.

Q: How long do the symptoms last?

• A: Since MS affects every person differently, it’s impossible to predict how long symptoms will last. Depending on the vision problem the person is experiencing, symptoms may persist for a few weeks or for a year or more.