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Visual Symptoms Associated With Choroidal Neovascularization: Photopsias and the Charles Bonnet Syndrome

Visual Symptoms Associated With Choroidal Neovascularization: Photopsias and the Charles Bonnet... Abstract • One hundred consecutive patients with macular choroidal neovascularization were studied in a cross-sectional fashion. Evidence of bilateral choroidal neovascularization was present in 31 patients. Among the 100 subjects, 59% related a history of seeing flickering or flashing lights (photopsias) in the affected eye or eyes. The colors varied, but in 59% of instances the lights were white. Twelve subjects experienced formed hallucinations (Charles Bonnet syndrome); in nine (75%) of these patients, the sequelae of choroidal neovascularization were bilateral. Symptoms that are commonly attributed to vitreoretinal tractional phenomena as well as neurologic and/or psychiatric disease are also frequently encountered in patients with macular degeneration associated with choroidal neovascularization. References 1. Folk JC. Aging macular degeneration: clinical features of treatable disease . Ophthalmology . 1985;92:594-602.Crossref 2. Fine AM, Elman MJ, Ebert JE, Prestia PA, Starr JS, Fine SL. Earliest symptoms caused by neovascular membranes in the macula . Arch Ophthalmol . 1986;104:513-514.Crossref 3. Soubrane G, Coscas G, Francais C, Koenig F. Occult subretinal new vessels in age-related macular degeneration . Ophthalmology . 1990;97:649-657.Crossref 4. Gass JDM. Pathogenesis of disciform detachment of the neuroepithelium, III: senile disciform macular degeneration . Am J Ophthalmol . 1967;63:617-644. 5. Sarks SH. New vessel formation beneath the retinal pigment epithelium in senile eyes . Br J Ophthalmol . 1973;57:951-965.Crossref 6. Green WR, Key SN. Senile macular degeneration: a histopathologic study . Trans Am Ophthalmol Soc . 1977;75:180-250. 7. Hensyl WR, ed. Stedman's Medical Dictionary . Baltimore, Md: Williams & Wilkins; 1990. 8. Orman WA. Visual hallucinations in sane people . BMJ . 1925;3:376-378. 9. Macular Photocoagulation Study Group. Argon laser photocoagulation for senile macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1982;100:912-918.Crossref 10. The Moorfields Macular Study Group. Treatment of senile disciform macular degeneration: a single-blind randomised trial by argon laser photocoagulation . Br J Ophthalmol . 1982;66:745-753.Crossref 11. Bressler SB, Bressler NM, Fine SL, et al. Natural course of choroidal neovascular membranes within the foveal avascular zone in senile macular degeneration . Am J Ophthalmol . 1982;93:157-163. 12. Bressler NM, Bressler SB, Gragoudas ES. Clinical characteristics of choroidal neovascular membranes . Arch Ophthalmol . 1987;105:209-213.Crossref 13. Vinding T. Visual impairment of age-related macular degeneration: an epidemiologic study of 1000 aged individuals . Acta Ophthalmol . 1990;68:162-167.Crossref 14. Siatkowski RM, Zimmer B, Rosenberg PR. The Charles Bonnet syndrome: visual perceptive dysfunction in sensory deprivation . J Clin Neuro Ophthalmol . 1990;10:215-218. 15. Schepens CL. Retinal Detachment and Allied Diseases . Philadelphia, Pa: WB Saunders Co; 1983;1:279-288. 16. Weleber RG. Retinitis pigmentosa and allied disorders . In: Ryan SJ, ed. Retina . Baltimore, Md: Mosby-Year Book; 1989;1:299-420. 17. Russell WR, Whitly CWM. Studies in traumatic epilepsy, III: visual fits . J Neurol Neurosurg Psychiatry . 1955;18:79-96.Crossref 18. Cogan DG. Visual hallucinations as release phenomena . Graefes Arch Clin Exp Ophthalmol . 1973;188:139-150.Crossref 19. Gass JDM. Stereoscopic Atlas of Macular Diseases . 3rd ed. St Louis, Mo: Mosby-Year Book; 1987:43-219. 20. Osterberg GA. Topography of the layer of rods and cones in the human retina . Acta Ophthalmol . 1935;6( (suppl) ):1-103. 21. White NJ. Complex visual hallucinations in partial blindness due to eye disease . Br J Psychiatry . 1980;136:284-286.Crossref 22. Berrios GE, Brook P. The Charles Bonnet syndrome and the problem of visual perceptual disorders in the elderly . Age Ageing . 1982;11:17-23.Crossref 23. Damas-Mora J, Skelton-Robinson M, Jenner FA. The Charles Bonnet syndrome in perspective . Psychol Med . 1982;12:251-261.Crossref 24. Olbrich HM, Lodemann E, Engelmeier MP. Optische Halluzinationen bei älteren Menschen mit Erkrankungen des Auges . Z Gerontol . 1987;20:227-229. 25. Rosenbaum F, Harate Y, Rolak L, Freedman M. Visual hallucinations in sane people: Charles Bonnet syndrome . J Am Geriatr Soc . 1987;35:66-68. 26. Casey PA, Wardzilak T. Senile macular degeneration and psychosis . J Geriatr Psychiatry Neurol . 1988;1:108-109.Crossref 27. Macular Photocoagulation Study Group. Argon laser photocoagulation for ocular histoplasmosis: results of a randomized clinical trial . Arch Ophthalmol . 1983;101:1347-1357.Crossref 28. Macular Photocoagulation Study Group. Argon laser photocoagulation for idiopathic neovascularization: results of a randomized clinical trial . Arch Ophthalmol . 1983;101:1358-1361.Crossref 29. Weinberger LM, Grant FC. Visual hallucinations and their neuro-optical correlates . Arch Ophthalmol . 1940;23:166-179.Crossref 30. Cooper AF, Porter R. Visual acuity and ocular pathology in the paranoid and affective psychoses of later life . J Psychosom Res . 1976;20:107-114.Crossref 31. Adams RD. Schizophrenia, paranoia, puerperal and endocrine psychoses . In: Wintrobe MM, Thorn GW, Adams RD, et al, eds. Harrison's Principles of Internal Medicine . 6th ed. New York, NY: McGraw-Hill International Book Co; 1970: 1877-1887. 32. Gross MM, Rosenblatt SM, Lewis E, Malenowski B, Broman M. Hallucinations and clouding of sensorium in alcohol withdrawal . Q J Stud Alcohol . 1971;32:1061-1069. 33. Hart CT. Formed visual hallucinations: a symptom of cranial arteritis . BMJ . 1967;3:643-644.Crossref 34. Levine AM. Visual hallucinations and cataracts . Ophthalmic Surg . 1980;11:95-98. 35. Bartlett JEA. A case of organized visual hallucinations in an old man with cataract and their relation to the phenomena of the phantom limb . Brain . 1951;74:363-373.Crossref 36. Ziskind E, Jones H, Filante W, Goldberg J. Observations on mental symptoms in eye patched patients: hypnagogic symptoms in sensory deprivation . Am J Psychiatry . 1966:893-900. 37. Weisman AD, Hackett TP. Psychosis after eye surgery . N Engl J Med . 1958;258:1284-1289.Crossref 38. Physician's Desk Reference . Oradell, NJ: Medical Economics Books; 1990:714-715. 39. Gregerman I. The thyroid gland . In: Harvey A, Johns R, McKusick V, et al, eds. The Principles and Practice of Medicine . East Norwalk, Conn: Appleton & Lange; 1984:815-839. 40. DeMosier G. Les hallucinations . Rev Oto Neuro Ophthalmol . 1938;16:244-352. 41. Bonnet C. Essai Analytique sur les Facultes de l'Ame . 2nd ed. Geneva, Switzerland: Philibert; 1769;2:176-177. 42. DeMosier G. Le syndrome de Charles Bonnet: hallucinations visuelles des vieillards sans deficience mentale . Ann Med Psychol . 1967;125:677-702. 43. Lance JW. Simple formed hallucinations confined to the area of a specific visual field defect . Brain . 1976;99:719-734.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Visual Symptoms Associated With Choroidal Neovascularization: Photopsias and the Charles Bonnet Syndrome

Archives of Ophthalmology , Volume 110 (9) – Sep 1, 1992

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American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1992.01080210069027
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Abstract

Abstract • One hundred consecutive patients with macular choroidal neovascularization were studied in a cross-sectional fashion. Evidence of bilateral choroidal neovascularization was present in 31 patients. Among the 100 subjects, 59% related a history of seeing flickering or flashing lights (photopsias) in the affected eye or eyes. The colors varied, but in 59% of instances the lights were white. Twelve subjects experienced formed hallucinations (Charles Bonnet syndrome); in nine (75%) of these patients, the sequelae of choroidal neovascularization were bilateral. Symptoms that are commonly attributed to vitreoretinal tractional phenomena as well as neurologic and/or psychiatric disease are also frequently encountered in patients with macular degeneration associated with choroidal neovascularization. References 1. Folk JC. Aging macular degeneration: clinical features of treatable disease . Ophthalmology . 1985;92:594-602.Crossref 2. Fine AM, Elman MJ, Ebert JE, Prestia PA, Starr JS, Fine SL. Earliest symptoms caused by neovascular membranes in the macula . Arch Ophthalmol . 1986;104:513-514.Crossref 3. Soubrane G, Coscas G, Francais C, Koenig F. Occult subretinal new vessels in age-related macular degeneration . Ophthalmology . 1990;97:649-657.Crossref 4. Gass JDM. Pathogenesis of disciform detachment of the neuroepithelium, III: senile disciform macular degeneration . Am J Ophthalmol . 1967;63:617-644. 5. Sarks SH. New vessel formation beneath the retinal pigment epithelium in senile eyes . Br J Ophthalmol . 1973;57:951-965.Crossref 6. Green WR, Key SN. Senile macular degeneration: a histopathologic study . Trans Am Ophthalmol Soc . 1977;75:180-250. 7. Hensyl WR, ed. Stedman's Medical Dictionary . Baltimore, Md: Williams & Wilkins; 1990. 8. Orman WA. Visual hallucinations in sane people . BMJ . 1925;3:376-378. 9. Macular Photocoagulation Study Group. Argon laser photocoagulation for senile macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1982;100:912-918.Crossref 10. The Moorfields Macular Study Group. Treatment of senile disciform macular degeneration: a single-blind randomised trial by argon laser photocoagulation . Br J Ophthalmol . 1982;66:745-753.Crossref 11. Bressler SB, Bressler NM, Fine SL, et al. Natural course of choroidal neovascular membranes within the foveal avascular zone in senile macular degeneration . Am J Ophthalmol . 1982;93:157-163. 12. Bressler NM, Bressler SB, Gragoudas ES. Clinical characteristics of choroidal neovascular membranes . Arch Ophthalmol . 1987;105:209-213.Crossref 13. Vinding T. Visual impairment of age-related macular degeneration: an epidemiologic study of 1000 aged individuals . Acta Ophthalmol . 1990;68:162-167.Crossref 14. Siatkowski RM, Zimmer B, Rosenberg PR. The Charles Bonnet syndrome: visual perceptive dysfunction in sensory deprivation . J Clin Neuro Ophthalmol . 1990;10:215-218. 15. Schepens CL. Retinal Detachment and Allied Diseases . Philadelphia, Pa: WB Saunders Co; 1983;1:279-288. 16. Weleber RG. Retinitis pigmentosa and allied disorders . In: Ryan SJ, ed. Retina . Baltimore, Md: Mosby-Year Book; 1989;1:299-420. 17. Russell WR, Whitly CWM. Studies in traumatic epilepsy, III: visual fits . J Neurol Neurosurg Psychiatry . 1955;18:79-96.Crossref 18. Cogan DG. Visual hallucinations as release phenomena . Graefes Arch Clin Exp Ophthalmol . 1973;188:139-150.Crossref 19. Gass JDM. Stereoscopic Atlas of Macular Diseases . 3rd ed. St Louis, Mo: Mosby-Year Book; 1987:43-219. 20. Osterberg GA. Topography of the layer of rods and cones in the human retina . Acta Ophthalmol . 1935;6( (suppl) ):1-103. 21. White NJ. Complex visual hallucinations in partial blindness due to eye disease . Br J Psychiatry . 1980;136:284-286.Crossref 22. Berrios GE, Brook P. The Charles Bonnet syndrome and the problem of visual perceptual disorders in the elderly . Age Ageing . 1982;11:17-23.Crossref 23. Damas-Mora J, Skelton-Robinson M, Jenner FA. The Charles Bonnet syndrome in perspective . Psychol Med . 1982;12:251-261.Crossref 24. Olbrich HM, Lodemann E, Engelmeier MP. Optische Halluzinationen bei älteren Menschen mit Erkrankungen des Auges . Z Gerontol . 1987;20:227-229. 25. Rosenbaum F, Harate Y, Rolak L, Freedman M. Visual hallucinations in sane people: Charles Bonnet syndrome . J Am Geriatr Soc . 1987;35:66-68. 26. Casey PA, Wardzilak T. Senile macular degeneration and psychosis . J Geriatr Psychiatry Neurol . 1988;1:108-109.Crossref 27. Macular Photocoagulation Study Group. Argon laser photocoagulation for ocular histoplasmosis: results of a randomized clinical trial . Arch Ophthalmol . 1983;101:1347-1357.Crossref 28. Macular Photocoagulation Study Group. Argon laser photocoagulation for idiopathic neovascularization: results of a randomized clinical trial . Arch Ophthalmol . 1983;101:1358-1361.Crossref 29. Weinberger LM, Grant FC. Visual hallucinations and their neuro-optical correlates . Arch Ophthalmol . 1940;23:166-179.Crossref 30. Cooper AF, Porter R. Visual acuity and ocular pathology in the paranoid and affective psychoses of later life . J Psychosom Res . 1976;20:107-114.Crossref 31. Adams RD. Schizophrenia, paranoia, puerperal and endocrine psychoses . In: Wintrobe MM, Thorn GW, Adams RD, et al, eds. Harrison's Principles of Internal Medicine . 6th ed. New York, NY: McGraw-Hill International Book Co; 1970: 1877-1887. 32. Gross MM, Rosenblatt SM, Lewis E, Malenowski B, Broman M. Hallucinations and clouding of sensorium in alcohol withdrawal . Q J Stud Alcohol . 1971;32:1061-1069. 33. Hart CT. Formed visual hallucinations: a symptom of cranial arteritis . BMJ . 1967;3:643-644.Crossref 34. Levine AM. Visual hallucinations and cataracts . Ophthalmic Surg . 1980;11:95-98. 35. Bartlett JEA. A case of organized visual hallucinations in an old man with cataract and their relation to the phenomena of the phantom limb . Brain . 1951;74:363-373.Crossref 36. Ziskind E, Jones H, Filante W, Goldberg J. Observations on mental symptoms in eye patched patients: hypnagogic symptoms in sensory deprivation . Am J Psychiatry . 1966:893-900. 37. Weisman AD, Hackett TP. Psychosis after eye surgery . N Engl J Med . 1958;258:1284-1289.Crossref 38. Physician's Desk Reference . Oradell, NJ: Medical Economics Books; 1990:714-715. 39. Gregerman I. The thyroid gland . In: Harvey A, Johns R, McKusick V, et al, eds. The Principles and Practice of Medicine . East Norwalk, Conn: Appleton & Lange; 1984:815-839. 40. DeMosier G. Les hallucinations . Rev Oto Neuro Ophthalmol . 1938;16:244-352. 41. Bonnet C. Essai Analytique sur les Facultes de l'Ame . 2nd ed. Geneva, Switzerland: Philibert; 1769;2:176-177. 42. DeMosier G. Le syndrome de Charles Bonnet: hallucinations visuelles des vieillards sans deficience mentale . Ann Med Psychol . 1967;125:677-702. 43. Lance JW. Simple formed hallucinations confined to the area of a specific visual field defect . Brain . 1976;99:719-734.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Sep 1, 1992

References