Visual Hallucinations in Age-Related Visual Impairment
Summary
Visual hallucinations are a recognised complication of significant vision loss in later life, most commonly manifested as Charles Bonnet syndrome. Individuals with reduced visual input may experience simple forms, such as shapes and flashes of light, or complex images, including people, animals or scenes. Though the retina and optic pathways are structurally intact beyond the primary disease, altered sensory input can lead to spontaneous cortical activity, perceptual disinhibition and a sense of unwanted imagery. These hallucinations may be distressing, challenge daily functioning and are often under-recognised by both patients and clinicians. Recent work has advanced understanding of the neural mechanisms, highlighted the psychosocial burden and explored novel therapeutic strategies. Awareness of this phenomenon is essential in an ageing population where age-related macular degeneration, glaucoma and other ocular conditions are prevalent globally.
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Visual Hallucinations in Age-Related Visual Impairment publication trend
The graph below shows the total number of articles in visual hallucinations in age-related visual impairment across all publications each year (not limited to Nature Index journals).
Technical terms
Charles Bonnet syndrome: The occurrence of complex visual hallucinations in cognitively intact individuals following significant vision loss.
Deafferentation: A reduction or loss of sensory input to a neural region, leading to compensatory hyperactivity.
Cortical excitability: The readiness of cortical neurons to fire action potentials in response to stimulation, often assessed via EEG or TMS thresholds.
Transcranial direct current stimulation (tDCS): A non-invasive technique delivering low-intensity electrical currents to modulate cortical excitability.
Fractional anisotropy: A measure of directional water diffusion in white matter, used in diffusion tensor imaging to assess tract integrity.
References
- Visual cortical activity in Charles Bonnet syndrome: testing the deafferentation hypothesis. Journal of Neurology (2025).
- An overview of psychological and social factors in Charles Bonnet syndrome. Therapeutic Advances in Ophthalmology (2021).
- How do the blind ‘see’? The role of spontaneous brain activity in self-generated perception. Brain (2020).
- Transcranial Direct Current Stimulation in the Treatment of Visual Hallucinations in Charles Bonnet Syndrome A Randomized Placebo-Controlled Crossover Trial. Ophthalmology (2022).
- Investigation of structural brain changes in Charles Bonnet Syndrome. NeuroImage Clinical (2022).
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