Seeing Things That Aren't There
A woman who has AMD recently wrote me with the following problem:
I have macular macula degeneration with loss of vision. I see things that aren't there. I have had these for over two months and the images I see never go away. My doctor tells me that these images are caused by retinal migraines. Can you explain what is going on? Thank you.
Answer: I think this person is suffering from the Charles Bonnet Syndrome and not retinal migraines. I have written a book about AMD titled, “Save Your Sight. How to Keep Your Vision in the Epidemic of Age-Related Macular Degeneration.” The book should be out in late February. Following is a paragraph from “Save Your Sight” which discusses this phenomenon:
"If you have lost vision in both eyes you may have hallucinations. These may be simple hallucinations such as streaks of light, or they may be complex hallucinations of objects and people and sometimes even whole scenes that move. The formed hallucinations have been termed the Charles Bonnet Syndrome after the man who described them after talking to his blind grandfather. Both types of hallucinations are thought to be a “release phenomenon” in the brain, which occur because the brain isn’t getting the normal impulses from the eye. You may be frightened by what you’re “seeing” or be reluctant to tell you doctor because you fear you may be going crazy or getting senile, but the hallucinations have no medical significance and are common. You should mention them to your doctor mainly so he or she can reassure you. Most people never get to the point where they enjoy their hallucinations but with reassurance they’re usually able to ignore them or even laugh when they tell others about what they’re “seeing.”
Classic migraines begin with a visual disturbance that begins in the peripheral vision. The disturbance often looks like a semi-circular, jagged, shimmering light, which enlarges and becomes more central. This disturbance usually obscures the vision within the jagged area. The light is often described a pale pastel in color. Typically, the visual disturbance lasts in the neighborhood of 15 minutes (up to 45 minutes) and then goes away. The episode may or may not be followed by a headache. If the central vision blurs, the patient is said to have an ocular or retinal migraine even though the disturbance is in the brain. Most retinal migraines are not followed by a headache. A retinal migraine causes visual blurring but the patient doesn’t “see things.” Retinal migraines rarely occur repeatedly during a day but aren’t continuous.
References:
Brown GC, Murphy RP. Visual symptoms associated with choroidal neovascularization: Photopsias and the Charles Bonnet syndrome. Arch Ophthalmol 1992; 110: 1251-1256.
Holroyd S, Rabins PV, Finkelstein D, Nicholson MC, Chase GA, Wisniewski SC. Visual hallucinations in patients with macular degeneration. Am J Psychiatry 1992; 149: 1701-1706.
Menon, GJ. Complex visual hallucinations in the visually impaired: A structured history-taking approach. Arch Ophthalmol 2005; 123: 349-355.
I have macular macula degeneration with loss of vision. I see things that aren't there. I have had these for over two months and the images I see never go away. My doctor tells me that these images are caused by retinal migraines. Can you explain what is going on? Thank you.
"If you have lost vision in both eyes you may have hallucinations. These may be simple hallucinations such as streaks of light, or they may be complex hallucinations of objects and people and sometimes even whole scenes that move. The formed hallucinations have been termed the Charles Bonnet Syndrome after the man who described them after talking to his blind grandfather. Both types of hallucinations are thought to be a “release phenomenon” in the brain, which occur because the brain isn’t getting the normal impulses from the eye. You may be frightened by what you’re “seeing” or be reluctant to tell you doctor because you fear you may be going crazy or getting senile, but the hallucinations have no medical significance and are common. You should mention them to your doctor mainly so he or she can reassure you. Most people never get to the point where they enjoy their hallucinations but with reassurance they’re usually able to ignore them or even laugh when they tell others about what they’re “seeing.”
Classic migraines begin with a visual disturbance that begins in the peripheral vision. The disturbance often looks like a semi-circular, jagged, shimmering light, which enlarges and becomes more central. This disturbance usually obscures the vision within the jagged area. The light is often described a pale pastel in color. Typically, the visual disturbance lasts in the neighborhood of 15 minutes (up to 45 minutes) and then goes away. The episode may or may not be followed by a headache. If the central vision blurs, the patient is said to have an ocular or retinal migraine even though the disturbance is in the brain. Most retinal migraines are not followed by a headache. A retinal migraine causes visual blurring but the patient doesn’t “see things.” Retinal migraines rarely occur repeatedly during a day but aren’t continuous.
References:
Brown GC, Murphy RP. Visual symptoms associated with choroidal neovascularization: Photopsias and the Charles Bonnet syndrome. Arch Ophthalmol 1992; 110: 1251-1256.
Holroyd S, Rabins PV, Finkelstein D, Nicholson MC, Chase GA, Wisniewski SC. Visual hallucinations in patients with macular degeneration. Am J Psychiatry 1992; 149: 1701-1706.
Menon, GJ. Complex visual hallucinations in the visually impaired: A structured history-taking approach. Arch Ophthalmol 2005; 123: 349-355.
posted by James C. Folk, M.D. at 9:56 AM
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