Charles Bonnet syndrome among visually impaired military veterans: findings from a UK screening and survey study

Background/Aims Charles Bonnet syndrome (CBS) is a common complication of visual impairment. However, demographic and clinical characteristics may modify the prevalence and impact of the condition. The aim was to investigate the prevalence of CBS among visually impaired military veterans and the ass...

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Main Authors: Matthew Lee, Mariya Moosajee, Lee Jones, Sonali Dave, Lara Ditzel-Finn, Judith Potts, Nikki Heinze, Renata S M Gomes, Eunice S Y Tang
Format: Article
Language:English
Published: BMJ Publishing Group 2025-04-01
Series:BMJ Open Ophthalmology
Online Access:https://bmjophth.bmj.com/content/10/1/e001781.full
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author Matthew Lee
Mariya Moosajee
Lee Jones
Sonali Dave
Lara Ditzel-Finn
Judith Potts
Nikki Heinze
Renata S M Gomes
Eunice S Y Tang
author_facet Matthew Lee
Mariya Moosajee
Lee Jones
Sonali Dave
Lara Ditzel-Finn
Judith Potts
Nikki Heinze
Renata S M Gomes
Eunice S Y Tang
author_sort Matthew Lee
collection DOAJ
description Background/Aims Charles Bonnet syndrome (CBS) is a common complication of visual impairment. However, demographic and clinical characteristics may modify the prevalence and impact of the condition. The aim was to investigate the prevalence of CBS among visually impaired military veterans and the associated impact of visual hallucinations.Methods Cross-sectional screening and survey study of members at Blind Veterans UK, a national charity supporting ex-armed forces men and women with a registered visual impairment. Data were analysed using membership records followed by a prospective CBS screening measure and survey.Results 461 military veterans with CBS were identified from 4109 individual records, representing 11.2% (95% CI 10.2% to 12.2%) of the population. From this, 115 members (24.9%) participated in the survey. The average age was 82.5 (±12.3) years and 89.6% were male. The most common ophthalmic condition was age-related macular degeneration (58.3%) and participants had severely reduced visual acuity (average better eye 1.2 (±1.4) LogMAR). Reporting ‘bothersome’ hallucinations was associated with living with CBS for over 3 years (p=0.01) and hallucinating at least once per week (p=0.05). Diverting attention elsewhere was considered an effective relief strategy among 64.9% (95% CI 56.2% to 73.6%) of those who had used this. Fewer than half (44.3%) had disclosed their symptoms to a hospital doctor and corresponding clinical management was variable.Conclusion CBS was common among visually impaired military veterans and was associated with negative outcomes. However, limitations include identifying cases through retrospective screening and not controlling for visual acuity and rehabilitation. Findings may not generalise beyond veterans in the charity’s database. Yet, the findings yield evidence for a therapeutic benefit of relief strategies in managing symptoms and the need to promote dialogue about visual hallucinations between patients and clinicians.
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spelling doaj-art-83830f79859c4e72b873bbed843fba1b2025-08-20T03:08:40ZengBMJ Publishing GroupBMJ Open Ophthalmology2397-32692025-04-0110110.1136/bmjophth-2024-001781Charles Bonnet syndrome among visually impaired military veterans: findings from a UK screening and survey studyMatthew Lee0Mariya Moosajee1Lee Jones2Sonali Dave3Lara Ditzel-Finn4Judith Potts5Nikki Heinze6Renata S M Gomes7Eunice S Y Tang8Blind Veterans UK, London, UKInstitute of Ophthalmology, University College London, London, UKInstitute of Ophthalmology, University College London, London, UKCity University of London, London, UKGreat Ormond Street Hospital for Children NHS Foundation Trust, London, UKEsme’s Umbrella, London, UKKing’s College London, London, UKNorthumbria University, Newcastle upon Tyne, UKInstitute of Education, University College London, London, UKBackground/Aims Charles Bonnet syndrome (CBS) is a common complication of visual impairment. However, demographic and clinical characteristics may modify the prevalence and impact of the condition. The aim was to investigate the prevalence of CBS among visually impaired military veterans and the associated impact of visual hallucinations.Methods Cross-sectional screening and survey study of members at Blind Veterans UK, a national charity supporting ex-armed forces men and women with a registered visual impairment. Data were analysed using membership records followed by a prospective CBS screening measure and survey.Results 461 military veterans with CBS were identified from 4109 individual records, representing 11.2% (95% CI 10.2% to 12.2%) of the population. From this, 115 members (24.9%) participated in the survey. The average age was 82.5 (±12.3) years and 89.6% were male. The most common ophthalmic condition was age-related macular degeneration (58.3%) and participants had severely reduced visual acuity (average better eye 1.2 (±1.4) LogMAR). Reporting ‘bothersome’ hallucinations was associated with living with CBS for over 3 years (p=0.01) and hallucinating at least once per week (p=0.05). Diverting attention elsewhere was considered an effective relief strategy among 64.9% (95% CI 56.2% to 73.6%) of those who had used this. Fewer than half (44.3%) had disclosed their symptoms to a hospital doctor and corresponding clinical management was variable.Conclusion CBS was common among visually impaired military veterans and was associated with negative outcomes. However, limitations include identifying cases through retrospective screening and not controlling for visual acuity and rehabilitation. Findings may not generalise beyond veterans in the charity’s database. Yet, the findings yield evidence for a therapeutic benefit of relief strategies in managing symptoms and the need to promote dialogue about visual hallucinations between patients and clinicians.https://bmjophth.bmj.com/content/10/1/e001781.full
spellingShingle Matthew Lee
Mariya Moosajee
Lee Jones
Sonali Dave
Lara Ditzel-Finn
Judith Potts
Nikki Heinze
Renata S M Gomes
Eunice S Y Tang
Charles Bonnet syndrome among visually impaired military veterans: findings from a UK screening and survey study
BMJ Open Ophthalmology
title Charles Bonnet syndrome among visually impaired military veterans: findings from a UK screening and survey study
title_full Charles Bonnet syndrome among visually impaired military veterans: findings from a UK screening and survey study
title_fullStr Charles Bonnet syndrome among visually impaired military veterans: findings from a UK screening and survey study
title_full_unstemmed Charles Bonnet syndrome among visually impaired military veterans: findings from a UK screening and survey study
title_short Charles Bonnet syndrome among visually impaired military veterans: findings from a UK screening and survey study
title_sort charles bonnet syndrome among visually impaired military veterans findings from a uk screening and survey study
url https://bmjophth.bmj.com/content/10/1/e001781.full
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