Charles Bonnet Syndrome in Visually Impaired Veterans

May 22, 2025 Matthew Lee

Matt and the CBS paper

Visual hallucinations are often associated with mental health conditions, but did you know they can also be a side effect of sight loss? This phenomenon is known as Charles Bonnet syndrome (CBS). A condition that is often under recognised, under discussed, and under supported.

A significant new study, published in BMJ Open Ophthalmology, has investigated the prevalence and impact of CBS specifically among visually impaired military veterans in the UK. Drawing on data from members of Blind Veterans UK, a charity supporting ex-armed forces personnel with sight loss, the research found that CBS is a common complication in this group. The study identified an estimated prevalence of 11.2% within this population, a figure is comparable to prevalence estimates found in wider visually impaired populations.

The visual hallucinations experienced by participants were diverse, with the majority reporting experiencing both simple shapes and complex images. The most common precepts were people (67%) and animals (59%). Many veterans in the study reported living with these hallucinations for more than 3 years, with over 70% experiencing them at least once per week.

While CBS hallucinations are unrelated to mental health disorders, the study revealed they can have a significant impact. Over half (52.2%) of participants found their hallucinations to be 'bothersome' or a nuisance, particularly if they occurred frequently or lasted longer. Nearly 40% reported them as 'scary' or concerning.

Encouragingly, the study indicates that simple behavioural strategies can offer therapeutic benefit in managing these symptoms. Among participants who had attempted relief strategies, diverting attention elsewhere was considered effective by 64.9% of those who used it.

Despite the impact and potential for self management strategies, the study highlights challenges in patient care. Disclosure rates remain low, with less than half of participants having discussed their CBS with a hospital doctor or consultant (44.3%) and even fewer with a GP (13%). Furthermore, the clinical management reported by participants was variable, with limited provision of information leaflets or referrals to support networks.

These findings underscore a clear need to increase awareness and improve dialogue about CBS among both visually impaired individuals and healthcare professionals. Forewarning patients at risk and encouraging disclosure is considered a first-line management strategy.

I produce a podcast episode that aims to summarise the findings in an accessible format https://youtu.be/7AX7vFBznUA

To understand the full scope of these findings and their implications for improving support and clinical management for visually impaired military veterans affected by CBS, we encourage you to read the complete paper. https://doi.org/10.1136/bmjophth-2024-001781

🌐 For support and advocacy on CBS please visit Esme’s Umbrella, the UK's dedicated CBS charity. https://www.charlesbonnetsyndrome.uk/

👉 If you work in eye care, veterans' health, or policy, please read and share this paper.

#CharlesBonnetSyndrome #SightLoss #VeteransHealth #HealthPolicy #LowVision #Ophthalmology #MentalHealth #EsmesUmbrella #InclusiveCare.