Article 4 Charles Bonnet Syndrome: Comprehensive Review Providing an Optometric Approach to Diagnosis and Management

Given the aging population, the likelihood of eye care providers encountering Charles Bonnet syndrome (CBS) will be high. Awareness of CBS is essential so that misdiagnosis and subsequent treatment for a non-existent psychiatric disease is prevented. After vision loss, patients can experience simple hallucinations such as unformed shapes or patterns, or complex hallucinations in the form of recognizable figures or faces. The prevalence of CBS is likely underestimated since individuals are hesitant to discuss these visual disturbances for fear of being labeled as mentally unstable. Since CBS is a diagnosis of exclusion, an extensive list of etiologies must be ruled out before the diagnosis is confirmed. Referrals to other medical disciplines are essential to ensure that the patient does not have another serious neurologic, psychiatric, or metabolic disorder that may be triggering the hallucinations. This comprehensive review is designed to update the reader on recent advances into understanding the pathophysiology of CBS. It is important to classify and differentiate CBS from other types of visual hallucinations. Since there are no universal standardized criteria for diagnosis and treatment, we hope to elucidate and provide the clinician with current diagnostic criteria, recommended work-up, and management plans for CBS patients.