The Charles Bonnet Syndrome in Patients With Neovascular Age-Related Macular Degeneration: Association With Proton Pump Inhibitors

Abstract

PURPOSE. We investigate the prevalence of the Charles Bonnet syndrome (CBS) in patients with neovascular age-related macular degeneration (AMD) and analyze the role of oral proton pump inhibitors (PPIs) and other potential risk factors. METHODS. A total of 510 consecutive patients with neovascular-AMD followed at a single tertiary center in Portugal were screened for CBS. Using a structured questionnaire, psychiatrically healthy individuals were interviewed systematically and divided into a CBS group and a non-CBS group. Demographic data, current medication, and ocular risk factors were collected and compared between the two groups. RESULTS. A total of 500 patients met the inclusion criteria and 471 with complete data were included in the final analysis. The prevalence of CBS was 9.0% (45/500). Using a binary logistic regression model, correlations were found between older age (P ¼ 0.002), PPI intake (P ¼ 0.022), poor visual acuity (P ¼ 0.004), and development of CBS. PPIs doubled the risk of CBS from 7% (20/304) to 15% (25/167), with an odds ratio of 2.154. The increased risk for visual hallucinations caused by PPIs was independent of age (P ¼ 0.598) and visual acuity (P ¼ 0.739). CONCLUSIONS. The prevalence of CBS in neovascular-AMD patients is high and mainly affects older individuals with poor visual acuity. PPIs seem to increase the risk of development of hallucinations independently of the degree of visual loss.

Prevalence of Charles Bonnet syndrome in patients with age‐related macular degeneration: systematic review and meta‐analysis

“…(), Hou & Zhang (), Singh & Sørensen (), and Leandro et al. () all reported on patients with neovascular AMD consecutively seen in a clinical context, which may be more representative of the population seen in clinical practice. In these patients, the presence of CBS was associated with older age, worse BCVA, and intake of proton pump inhibitors (Leandro et al.…”

“…In these patients, the presence of CBS was associated with older age, worse BCVA, and intake of proton pump inhibitors (Leandro et al. ). Singh & Sørensen () also found that patients who experienced CBS were more likely to be female and have lower BCVA in best‐seeing eye.…”

“…Subjects who responded positively were interviewed in detail using a structured questionnaire on the incidence and complexity of visual hallucinations. Diagnostic criteria for CBS were: (1) at least one complex visual hallucination within the past 4 weeks; (2) period between the first hallucination and last hallucination not exceeding 4 weeks; (3) full or partial retention of insight into the unreal nature of the hallucinations; (4) the absence of hallucinations in other sensory modalities; and (5) the absence of delusions Leandro et al (2017) Patients were asked 'We are asking this question to every patient being examined here. Sometimes people with poor eyesight see things that they know are not actually there.…”

“…Brown & Murphy (1992), Mitrut et al (2010), Zhang et al (2012), Hou & Zhang (2012), Singh & Sørensen (2012), and Leandro et al (2017) all reported on patients with neovascular AMD consecutively seen in a clinical context, which may be more representative of the population seen in clinical practice. In these patients, the presence of CBS was associated with older age, worse BCVA, and intake of proton pump inhibitors (Leandro et al 2017). Singh & Sørensen (2012) also found that patients who experienced CBS were more likely to be female and have lower BCVA in best-seeing eye.…”

Clinical Characteristics of the Charles Bonnet Syndrome in Patients with Neovascular Age-Related Macular Degeneration: The Importance of Early Detection

“…Other risk factors that have been identified include age, social isolation, sensorial deprivation (including hear loss), low level of education, cerebrovascular disease, fatigue, and stress [5-7]. We have recently reported some of the related risk factors for CBS in a population of neovascular AMD patients [8]. Besides the influence of older age and visual impairment, proton pump inhibitor (PPI) intake was associated with a 2 times greater risk of developing the syndrome and should be recognized as a possible modifiable factor for CBS.…”