Charles Bonnet’s syndrome: not only a condition of the elderly

  • Heike M. Elflein
  • M. Rudy
  • K. Lorenz
  • K. A. Ponto
  • A. Scheurich
  • S. Pitz
Low Vision



To investigate whether the experience of visual hallucinations, namely Charles Bonnet’s syndrome, in psychologically healthy people is a phenomenon solely of elderly, visually impaired people.


In a prospective controlled study, four groups of subjects (total 324) were formed: age ≤40 years, no visual impairment; age ≤40 years, visually impaired; age >40 years, no visual impairment; age >40 years, visually impaired. Visual impairment was defined as best-corrected visual acuity ≤0.3 (Snellen) in the better-seeing eye. Each group consisted of 81 subjects. Visual hallucinations were defined as complex visual perceptions. After ruling out psychiatric causes for visual hallucinations or medication related to the experience of visual hallucinations, affected subjects underwent a detailed interview about their visual hallucinations.


The prevalence of visual hallucinations among young subjects with visual impairment was 4.9 %; among the elderly visually impaired subjects, it was 6.2 %. The difference was not statistically significant. No subject without visual impairment experienced visual hallucinations.


Charles Bonnet’s syndrome is not limited to elderly people suffering from visual impairment, though there tends to be a higher prevalence of visual hallucinations in this group.


Charles Bonnet’s syndrome Visual hallucinations Visual impairment 



This manuscript contains parts of the thesis of Marlene Rudy.

Compliance with ethical standards


KA Ponto is funded by the Federal Ministry of Education and Research (BMBF 01EO1003).

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants or their legal guardians included in the study.


  1. 1.
    de Morsier G (1967) The Charles Bonnet syndrome: visual hallucinations in the aged without mental deficiency. Ann Med Psychol (Paris) 2:678–702Google Scholar
  2. 2.
    Hedges TR Jr (2007) Charles Bonnet, his life, and his syndrome. Surv Ophthalmol 52:111–114. doi: 10.1016/j.survophthal.2006.10.007 CrossRefPubMedGoogle Scholar
  3. 3.
    Batra A, Bartels M, Wormstall H (1997) Therapeutic options in Charles Bonnet syndrome. Acta Psychiatr Scand 96:129–133CrossRefPubMedGoogle Scholar
  4. 4.
    Podoll K, Osterheider M, Noth J (1989) The Charles Bonnet syndrome. Fortschr Neurol Psychiatr 57:43–60. doi: 10.1055/s-2007-1000744 CrossRefPubMedGoogle Scholar
  5. 5.
    Olbrich HM, Engelmeier MP, Pauleikhoff D, Waubke T (1987) Visual hallucinations in ophthalmology. Graefes Arch Clin Exp Ophthalmol 225:217–220CrossRefPubMedGoogle Scholar
  6. 6.
    Teunisse RJ, Cruysberg JR, Verbeek A, Zitman FG (1995) The Charles Bonnet syndrome: a large prospective study in The Netherlands. A study of the prevalence of the Charles Bonnet syndrome and associated factors in 500 patients attending the University Department of Ophthalmology at Nijmegen. Br J Psychiatry J Ment Sci 166:254–257CrossRefGoogle Scholar
  7. 7.
    Nesher R, Nesher G, Epstein E, Assia E (2001) Charles Bonnet syndrome in glaucoma patients with low vision. J Glaucoma 10:396–400CrossRefPubMedGoogle Scholar
  8. 8.
    Brown GC, Murphy RP (1992) Visual symptoms associated with choroidal neovascularization. Photopsias and the Charles Bonnet syndrome. Arch Ophthalmol 110:1251–1256CrossRefPubMedGoogle Scholar
  9. 9.
    Adachi N (1996) Charles Bonnet syndrome in leprosy; prevalence and clinical characteristics. Acta Psychiatr Scand 93:279–281CrossRefPubMedGoogle Scholar
  10. 10.
    Berrios GE, Brook P (1984) Visual hallucinations and sensory delusions in the elderly. Br J Psychiatry J Ment Sci 144:662–664CrossRefGoogle Scholar
  11. 11.
    Norton-Willson L, Munir M (1987) Visual perceptual disorders resembling the Charles Bonnet syndrome. A study of 434 consecutive patients referred to a psychogeriatric unit. Fam Pract 4:27–35CrossRefPubMedGoogle Scholar
  12. 12.
    Tan CS, Lim VS, Ho DY, Yeo E, Ng BY, Au Eong KG (2004) Charles Bonnet syndrome in Asian patients in a tertiary ophthalmic centre. Br J Ophthalmol 88:1325–1329. doi: 10.1136/bjo.2004.041947 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Khan JC, Shahid H, Thurlby DA, Yates JR, Moore AT (2008) Charles Bonnet syndrome in age-related macular degeneration: the nature and frequency of images in subjects with end-stage disease. Ophthalmic Epidemiol 15:202–208. doi: 10.1080/09286580801939320 CrossRefPubMedGoogle Scholar
  14. 14.
    Abbott EJ, Connor GB, Artes PH, Abadi RV (2007) Visual loss and visual hallucinations in patients with age-related macular degeneration (Charles Bonnet syndrome). Invest Ophthalmol Vis Sci 48:1416–1423. doi: 10.1167/iovs.06-0942 CrossRefPubMedGoogle Scholar
  15. 15.
    Menon GJ (2005) Complex visual hallucinations in the visually impaired: a structured history-taking approach. Arch Ophthalmol 123:349–355. doi: 10.1001/archopht.123.3.349 CrossRefPubMedGoogle Scholar
  16. 16.
    Ffytche DH, Howard RJ, Brammer MJ, David A, Woodruff P, Williams S (1998) The anatomy of conscious vision: an fMRI study of visual hallucinations. Nat Neurosci 1:738–742. doi: 10.1038/3738 CrossRefPubMedGoogle Scholar
  17. 17.
    Adachi N, Watanabe T, Matsuda H, Onuma T (2000) Hyperperfusion in the lateral temporal cortex, the striatum and the thalamus during complex visual hallucinations: single photon emission computed tomography findings in patients with Charles Bonnet syndrome. Psychiatry Clin Neurosci 54:157–162. doi: 10.1046/j.1440-1819.2000.00652.x CrossRefPubMedGoogle Scholar
  18. 18.
    Teunisse RJ, Cruysberg JR, Hoefnagels WH, Verbeek AL, Zitman FG (1996) Visual hallucinations in psychologically normal people: Charles Bonnet’s syndrome. Lancet 347:794–797CrossRefPubMedGoogle Scholar
  19. 19.
    Scheurich A, Muller MJ, Siessmeier T, Bartenstein P, Schmidt LG, Fellgiebel A (2005) Validating the DemTect with 18-fluoro-2-deoxy-glucose positron emission tomography as a sensitive neuropsychological screening test for early alzheimer disease in patients of a memory clinic. Dement Geriatr Cogn Disord 20:271–277. doi: 10.1159/000088248 CrossRefPubMedGoogle Scholar
  20. 20.
    Essau CA, Wittchen HU, Pfister H (1999) DIA-X-Interview. Diagnostica 45:163–164. doi: 10.1026//0012-1924.45.3.163 CrossRefGoogle Scholar
  21. 21.
    O’Hare F, Bentley SA, Wu Z, Guymer RH, Luu CD, Ayton LN (2015) Charles Bonnet syndrome in advanced retinitis pigmentosa. Ophthalmology 122:1951–1953. doi: 10.1016/j.ophtha.2015.03.006 CrossRefPubMedGoogle Scholar
  22. 22.
    Menon GJ, Rahman I, Menon SJ, Dutton GN (2003) Complex visual hallucinations in the visually impaired: the Charles Bonnet Syndrome. Surv Ophthalmol 48:58–72CrossRefPubMedGoogle Scholar
  23. 23.
    Gold K, Rabins PV (1989) Isolated visual hallucinations and the Charles Bonnet syndrome: a review of the literature and presentation of six cases. Compr Psychiatry 30:90–98CrossRefPubMedGoogle Scholar
  24. 24.
    Garcia-Ptacek S, Garcia Azorin D, Sanchez Salmador R, Cuadrado ML, Porta-Etessam J (2013) Hallucinations and aberrant perceptions are prevalent among the young healthy adult population. Neurologia 28:19–23. doi: 10.1016/j.nrl.2012.02.004 CrossRefPubMedGoogle Scholar
  25. 25.
    Gilmour G, Schreiber C, Ewing C (2009) An examination of the relationship between low vision and Charles Bonnet syndrome. Can J Ophthalmol 44:49–52. doi: 10.3129/i08-169 CrossRefPubMedGoogle Scholar
  26. 26.
    Holroyd S, Rabins PV, Finkelstein D, Lavrisha M (1994) Visual hallucinations in patients from an ophthalmology clinic and medical clinic population. J Nerv Ment Dis 182:273–276CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Heike M. Elflein
    • 1
  • M. Rudy
    • 1
  • K. Lorenz
    • 1
  • K. A. Ponto
    • 1
    • 2
  • A. Scheurich
    • 3
  • S. Pitz
    • 1
  1. 1.Department of OphthalmologyUniversity Medical CenterMainzGermany
  2. 2.Center for Thrombosis and Hemostasis (CTH)University Medical CenterMainzGermany
  3. 3.Department of Psychiatry and PsychotherapyUniversity Medical CenterMainzGermany

Personalised recommendations