Top 10 Articles of 2015

eye facts and eye disease
In looking at the many articles we shared with you in 2015, we found that your interests were varied. From the science of vision, eye facts and eye disease to helpful suggestions to help your vision.

Here is the list of the top 10 articles you read last year. Do you have a favorite that is not on the list? Share it in the comments section below.

    1. Rods and Cones Give Us Color, Detail and Night Vision
    2. 20 Facts About the Amazing Eye
    3. Understanding and Treating Corneal Scratches and Abrasions
    4. 32 Facts About Animal Eyes
    5. 20 Facts About Eye Color and Blinking
    6. When You See Things That Aren’t There
    7. Posterior Vitreous Detachment
    8. Can Keratoconus Progression Be Predicted?
    9. Winter Weather and Your Eyes
    10. Coffee and Glaucoma: “1-2 cups of coffee is probably fine, but…”

Do you have any topics you would like to see discussed in the blog? Please leave any suggestions you might have in the comments below.

1/7/16


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Are You Seeing Images That Aren’t There?

“I’m worried about my mother”, Janet said. “Lately, she’s been telling me that she sees things that aren’t there – bugs, flowers, faces floating in the air! Is she getting Alzheimers?! She’s healthy and has always been sharp as a tack, although she has macular degeneration. What should I do? Yesterday, she said some children were playing in her yard but there was no one there!”

Janet’s mom probably has Charles Bonnet Syndrome (CBS) which can affect anyone with a severe vision loss. People with CBS see things that are not there but they know they are not real.
charles bonnet syndrome images
They have reported a wide variety of images, including bugs, flowers, animals, people, trees, houses, balloons and patterns. In Dr. Lylas Mogk’s excellent book on macular degeneration, she describes a patient who saw monkeys wearing clothes, playing in the trees. Another person saw an entire dinner party in her dining room!

One study documented that 80% of the participants saw people; 38% saw animals. Children and groups of people were also common. Twenty-seven percent had them daily. For some people, the images lasted less than a minute, but for 53%, they continued for one minute to one hour.

The images come and go and are usually interesting or amusing and not threatening. Dr.Mogk states, “One of the most remarkable qualities of these figures is that they almost always wear pleasant expressions and often make eye contact with the viewer. Menacing behavior, grotesque shapes, and scenes of violent conflict are not, to my knowledge, a part of this syndrome.”

The same images usually repeat themselves – often at the same time of day. They may happen daily or infrequently. The person with CBS knows that they are not real, and is fully awake when they occur. In the study, 82% of people immediately knew that the images were not real. The rest were deceived only briefly and then because the images were such common objects.

The images don’t block out what is behind them and they don’t have any sound associated with them. They’re usually in color, but can be in black and white. They are very detailed – much more detailed than what the patient with macular degeneration can usually see. People may see anything and the images are usually not anything they’ve seen in real life; they don’t seem to be visual memories. We don’t know exactly why this happens; it may be that the brain is trying to show something in the absence of normal visual impulses.

Like “phantom limb syndrome”, the body experiences things that are not there. Between 10% and 21% of people with low vision experience CBS, but some studies put the number higher than 40%.

What To Do?

  • Letting your family or friends know about it can be helpful. Most people with CBS are afraid to say anything about it. “They’ll think I’m crazy!”, they say. But if you and they understand what’s going on, you can help each other deal with the issue. For instance, if you see a big spider on the wall, why not just tell someone, “I think I see a spider over there. Will you check for me?”.
  • Acknowledge the images and then move on with your day. One lady remarked that she just says, “Ok, I see you but I don’t have time for you now, so just go away.” Then, she finds it easier to ignore them. I mentioned this technique to another woman who laughingly said, “Oh, great. First I’m seeing things and now I’m going to talk to them? People really WILL think I’m crazy!”.
  • You do need to keep your sense of humor about this. You cannot MAKE them go away. Becoming angry or upset will not make the images any less strong or frequent. In fact, stress may be a factor in triggering a hallucination, as can fatigue, low light or bright light and inactivity.
  • Talk with your doctor about it. More and more eye doctors are learning about Charles Bonnet Syndrome. You’ll be reassured that what you are experiencing is shared by others. Although few people need it, there has been some research on the use of low dose drugs such as Haldol. Recognition and acceptance are often at least as effective.

On a positive note, patients do report that the hallucinations are reduced over time and eventually go away completely. At a recent support group meeting, one participant mentioned that hers had disappeared and wryly admitted that she missed them! She’d gotten used to them and they didn’t interfere with her daily life after a while.

Techniques

A research study in the Netherlands found that people used a variety of techniques that were helpful, in addition to the ideas above.

  • Close your eyes; open your eyes; blink or look quickly away from the image.
  • Walk away from the image or approach it.
  • Stare at the image.
  • Put on a light.
  • Concentrate on something else; distract yourself.

Thousands of people live with Charles Bonnet Syndrome and manage quite well – you are not alone!

One note of importance: If the experience does not seem to meet the description of Charles Bonnet Syndrome, further testing may be necessary. Other medical conditions can trigger hallucinations, such as Parkinson’s. A full neurological work-up is indicated if the images are frightening, threatening or are accompanied by sounds or bizarre sensations.

This article is from the NEW Macular Degeneration Partnership website – AMD.org.  If you enjoyed it, please check out other articles related to age-related macular degeneration and sign-up for the monthly AMD E-Updates.

References:

  1. Mogk, Lylas G. and Marja Mogk: Macular Degeneration, The Complete Guide to Saving and Maximizing Your Sight. New York: Ballantine Books, 1999, 2003.
  2. Teunisse, Robert J et al. “Visual Hallucinations in Psychologically Normal People: Charles Bonnet Syndrome: CBS.” The Lancet, Vol 347, (March 1996): p794-97.

Judi Delgado - age-related macular degenerationJudith Delgado
Executive Director
Macular Degeneration Partnership
A Program of Discovery Eye Foundation

When You See Things That Aren’t There

5/8/14

Charles Bonnet Syndrome


“Do you ever see anything you know is not there but looks real anyway?” I asked Sam Weinberg when he came to the Low Vision Living program.

“No.” he said, looking at his wife, Rachel, and fidgeting with his sweater.

“Oh”, I said casually, “I just asked because many people with macular degeneration see things they know are not there. I call it phantom vision, but the technical term is Charles Bonnet Syndrome.”

“Is this syndrome an early sign of Alzheimer’s?” Sam asked pointedly, still looking at Rachel. . .

“Absolutely not”, I said firmly. “Charles Bonnet Syndrome has nothing to do with mental agility or stability. When you have phantom vision, your mind is fine; it is your eyes that are playing tricks on you. It’s a side effect of low vision.”

“Well,” Sam admitted quickly, “I see little monkeys with red hats and blue coats playing in the front yard. I’ve seem them for eighteen months.”

“What!” Rachel’s eyes about popped out of her head. “Little monkeys in the front yard?”

“Well. . .um,” Sam continued, “sometimes I see them in the living room too.”

What is Charles Bonnet Syndrome (CBS)?
Charles Bonnet was an eighteenth century Swiss naturalist and philosopher. . . who described his grandfather’s curious experience of seeing men, women, birds and buildings that he knew were not there. Later in his life, Bonnet’s own vision deteriorated and he experienced phantom visions similar to his grandfather’s. . . .Charles Bonnet’s discovery didn’t capture medical attention at the time. But 150 years later, in the 1930’s, his files were dusted off, and he was credited with being the first person to describe the syndrome that came to be named for him.

Image seen by someone with CBS
Image seen by someone with CBS

How common is CBS?
This syndrome is very common. Studies place the number somewhere between 10 and 40 percent of people with low vision. Twenty percent of my low vision patients have Charles Bonnet Syndrome. . . To determine whether or not you are experiencing phantom vision: Do the images that appear to you have the following six characteristics?

  1. They occur when you are fully conscious and wide awake, often during broad daylight

  2. They do not deceive you; you are aware that they are not real.

  3. They occur in combination with normal perception. For example, you may see a sidewalk clearly but find it covered with dots, flowers, or faces.

  4. They are exclusively visual and do not appear in combination with any sounds or bizarre sensations.

  5. They appear and disappear without obvious cause.

  6. They are amusing or annoying but not grotesque.
An image described by a person with CBS
An image described by a person with CBS

What do people with CBS see?
My patients. . . have reported seeing cartoon characters, flowers in the bathroom sink, hands rubbing each other, waterfalls and mountains, tigers, maple trees in vibrant autumn foliage, yellow polka dots, row houses, a dinner party and brightly colored balloons. . . One of the most remarkable qualities of these figures is that they almost always wear pleasant expressions. . . Menacing behavior, grotesque shapes and scenes of violent conflict are not, to my knowledge, a part of this syndrome.

Usually the same image or set of images reappears to each person. Sam’s monkeys usually materialized around sunset. . .They stayed for 10 or 20 minutes several times a week for two years and then began to appear less frequently. Some times the images change of multiple images appear. . .

Little girls dancing in the yard
Little girls dancing in the yard

Dolly Kowalski’s Little Girls with Pink Bows
‘I see little girls with pink bows playing in my yard. At first, there was only one little girl. But after a while, she had several playmates. Now they come almost every evening for fifteen minutes. . .They are so delightful, so cheerful, so active. Their little white dresses and pink bows blow in the wind. I see them so incredibly clearly, much more clearly than I see anything else now. . . .I know they aren’t real, but you wouldn’t believe how realistic they seem. . . . I wish you could see them the way I do.’”

Further note by Lylas Mogk, MD
Fortunately, most people, like Dolly, find the images of CBS largely untroubling and many actually find them amusing or enjoyable, as they are usually pleasant and they are crystal clear. There is no drug treatment for CBS, but it is associated with sensory deprivation, so the more active and engaged one is the less likely it is to occur. That’s one reason why vision rehabilitation to empower individuals to accomplish their daily activities in spite of vision loss.

Excerpts were used from Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight, by Lylas G. Mogk, MD and Marja Mogk, PhD, New York: Ballantine Books, 2003, Chapter 8, pp. 236-252.

Mogk_Lylas_11C[1]Lylas G. Mogk, MD
Director, Center for Vision Rehabilitation and Research
Henry Ford Health System