EyeTools Question of the Day #352

One of my older patients with low vision told me that she could see small children sat in her living room at home when she knew that there was no one else in the house. What is going on?

Based on your information, of an older person with low vision living alone at least some of the time this sounds like a case of Charles Bonnet Syndrome. Over the last two years with an increase in the isolation of older people with poor eye sight there is very likely to be a significant increase in the incidence of this condition. My advice is to identify those of your patients who have poorer visual acuity than 6/12 in the better eye who are older than 65 years and who have little or no social contact with other people for periods of a week or more. These are the people who are most at risk of developing Charles Bonnet Syndrome. Then warn these people that there are at risk and explain that they may see things that they know aren’t there. I tell patients that this is the brain filling in the gaps in their vision. The appearance of these hallucinations often causes anxiety for the sufferer but if they have some sense beforehand that they may start to see things then this could give them some comfort. Advise them to contact you if they need further advice or give them the details of local a self-help group if there is one. I’ve seen a lot of people who have worried on their own for years after experiencing visual hallucinations and when I explain that this is a common occurrence in older people with poor eyesight living alone they wish that they had been forewarned about the possibility of seeing things and what to do if they did.

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