Charles Bonnet Syndrome in AMD (Visual Hallucinations)

The hallucinations in Charles Bonnet Syndrome vary widely from person to person. Many people see geometric patterns such as grids, brick-like shapes, or repeating tiles. Others see more complex images like people in period clothing, children, animals, or detailed landscapes.

• Brightly colored patterns or shapes that appear suddenly
• Faces of strangers, sometimes with unusual features or costumes
• Small figures of people or cartoon-like characters
• Vehicles, buildings, or garden scenes
• Images that often seem out of place in your current surroundings

Simple hallucinations are basic shapes, lines, dots, or flashes of light. These tend to be less detailed and may appear as random visual noise. Complex hallucinations involve fully formed images such as people, animals, or entire scenes that can look quite realistic.

Many patients experience both types at different times. The complexity does not indicate how severe your condition is, and both types are equally common in Charles Bonnet Syndrome.

Most hallucinations last anywhere from a few seconds to several minutes. Some episodes may continue for half an hour or longer, though this is less common. The images may appear and disappear suddenly, or they may fade in and out gradually.

Episodes can happen once in a while or multiple times throughout the day. The frequency and duration often change over time without any clear pattern.

Many people notice hallucinations more often in low-light conditions, such as early morning, evening, or in dimly lit rooms. Fatigue and stress can also make episodes more likely. Some patients find that hallucinations occur when they are quiet and relaxed, such as sitting in a chair or lying in bed.

• Dim lighting or transitions from bright to dark environments
• Being in unfamiliar surroundings with less visual detail
• Periods of boredom or reduced mental stimulation
• Times when you are alone and not actively engaged in a task

In Charles Bonnet Syndrome, you remain aware that the visions are not real and your thinking stays clear. If you experience confusion, memory problems, or believe the hallucinations are real, this may suggest a different neurological or psychiatric condition. Hallucinations involving sounds, smells, or touch are not part of Charles Bonnet Syndrome and should be reported to a doctor immediately.

We also watch for other warning signs such as sudden changes in your hallucinations, new neurological symptoms like weakness or speech difficulty, or personality changes. These require prompt medical evaluation to rule out stroke, dementia, or other serious conditions.

Some conditions that may resemble Charles Bonnet Syndrome include migraine aura, which often produces shimmering or expanding visual effects that are typically brief and may occur without headache. Retinal problems such as tears or detachment cause new flashes of light, sudden floaters, or a curtain or veil across your vision and require urgent eye evaluation. Medications or other substances can also cause visual hallucinations or worsen existing ones.

• Call for urgent eye evaluation if you notice new flashes of light or floating spots
• Contact us promptly if you see a curtain, shadow, or veil blocking part of your vision
• Report sudden drops in vision or new distortion that may signal wet AMD activity
• Tell your doctor about all medications and supplements you are taking

Currently, there is no medication or procedure specifically approved to cure Charles Bonnet Syndrome. The hallucinations are a direct result of vision loss, and because we cannot fully restore lost vision in most cases of advanced AMD, we cannot eliminate the underlying cause. However, many strategies can reduce the frequency and distress of hallucinations.

Our focus is on managing symptoms, maximizing your remaining vision, and helping you cope with the hallucinations when they occur. Over time, some patients find that their hallucinations become less frequent or bothersome even without specific treatment.

Treating the underlying age-related macular degeneration is an important part of managing Charles Bonnet Syndrome. For wet AMD, we may recommend injections of anti-VEGF medications to reduce abnormal blood vessel growth and slow further vision loss. For dry AMD, management depends on the stage of disease and your individual risk profile.

AREDS2 nutritional supplements are generally recommended for intermediate AMD or advanced AMD in one eye, not for early AMD. If you are a current or former smoker, you should use a formula without beta-carotene to avoid increasing lung cancer risk. Lifestyle changes such as smoking cessation and managing cardiovascular risk factors like blood pressure and cholesterol are also important for slowing AMD progression. For geographic atrophy, a more advanced form of dry AMD, intravitreal complement inhibitor therapies are now available for selected patients and may slow progression, though they do not restore lost vision.

• Timely treatment to prevent additional vision loss
• Ask whether you meet criteria for AREDS2 supplements and the right formulation for you
• Discuss geographic atrophy treatment options if applicable
• Stop smoking and optimize cardiovascular risk factors
• Use of low-vision aids such as magnifiers and better lighting
• Regular monitoring to catch any changes in your AMD early
• Optimizing your eyeglass prescription to make the most of available vision

Improving the lighting in your home can reduce hallucinations for many people. Bright, even lighting helps your eyes send clearer signals to your brain, leaving less room for the brain to fill in gaps with false images. Avoid sitting in dim rooms or facing blank walls, as low visual stimulation can trigger episodes.

Adding visual interest to your environment, such as colorful objects or patterns, may also help. Some patients find that keeping a television or radio on in the background provides enough sensory input to decrease hallucination frequency.

No medication is specifically approved for Charles Bonnet Syndrome as of 2025, but in some cases we may consider medications that have shown benefit in small studies or individual patients. These are used off-label and typically involve consultation with a neurologist or psychiatrist. Any medication decision is made carefully, weighing potential benefits against side effects.

We typically reserve medication for cases where hallucinations are frequent, distressing, or interfering significantly with your quality of life. Many patients manage well with education and behavioral strategies alone.

• Certain antiepileptic drugs in selected cases
• Atypical antipsychotic medications in selected cases
• Antidepressants when mood symptoms are also present
• Cholinesterase inhibitors when there is a comorbid cognitive disorder, typically managed by a specialist

In older adults, these medications carry risks including sedation, falls, confusion, heart rhythm changes, and interactions with other drugs. Never start or stop any medication for hallucinations without guidance from your prescribing clinician.

Some people find they can reduce or stop a hallucination by using specific mental techniques. Recognizing that the image is not real and calmly telling yourself it will pass can reduce anxiety. Shifting your attention to another task or engaging in conversation often makes the hallucination fade more quickly.

• Remind yourself that the images are harmless and will go away
• Focus your mind on a specific thought or memory
• Engage in a mental task such as counting or reciting a poem
• Practice relaxation breathing to reduce any fear or stress

Living with both vision loss and hallucinations can lead to feelings of sadness, worry, or frustration. If you develop symptoms of depression or anxiety, we may recommend counseling or medication to help you cope. Treating these emotional aspects can improve your overall well-being and may even reduce the impact of hallucinations.

Support from a mental health professional who understands vision loss can be very valuable. You do not have to manage these feelings alone.

No, Charles Bonnet Syndrome hallucinations do not indicate dementia. People with this syndrome typically maintain awareness that the visions are not real and usually have normal memory and thinking. If you notice memory loss, confusion, or changes in your ability to perform daily tasks, mention these to your doctor separately so we can evaluate them.

The relationship between AMD progression and hallucination severity varies. Some people experience more hallucinations if their vision worsens, while others find that hallucinations decrease over time as the brain adapts. In some cases, hallucinations may eventually stop on their own even if vision loss remains stable or worsens.

Charles Bonnet Syndrome is related to overall vision loss rather than which specific eye is affected. Because the hallucinations are generated by the brain in response to reduced visual input, they occur in your field of vision as a whole. People with vision loss in both eyes are at higher risk, but even significant loss in one eye can sometimes trigger the syndrome.

Driving safety depends on your visual acuity, visual field, contrast sensitivity, the frequency and nature of your hallucinations, and your local legal vision requirements. We will assess these factors with you individually. Any hallucination that occurs while you are driving requires you to pull over safely and stop driving until you have been evaluated. Many people with advanced AMD no longer meet legal vision standards for driving regardless of hallucinations.

Charles Bonnet Syndrome hallucinations themselves are not dangerous and do not harm your brain or eyes. After evaluation, CBS is often a benign release phenomenon related to vision loss, but we still monitor for medication effects and neurologic or cognitive changes over time. We conduct thorough testing to confirm the diagnosis and rule out other conditions that may require different treatment.