THE CHARLES–BONNET SYNDROME IN PATIENTS WITH NEOVASCULAR-AGE RELATED MACULAR DEGENERATION – COULD PROTON INHIBITOR PUMPS PLAY A ROLE?

Abstract

Purpose : The occurrence of visual hallucinations in psychologically healthy people – the Charles Bonnet Syndrome – is often associated with visual loss. We investigated the role of oral proton pump inhibitors (PPIs) use and other potential risk factors in a population of neovascular age-related macular degeneration (AMD) patients.

Methods : Five hundred consecutive patients with neovascular-AMD followed at a single tertiary center in Portugal were screened for CBS. Psychiatrically healthy individuals where systematically asked if they had previously experienced hallucinations, patients that fit the selection criteria were included in the CBS group and those who did not report hallucinations were included in the non-CBS group. Demographic data, current medication and ocular risk factors were collected from patient charts and compared between CBS and non-CBS groups.

Results : The prevalence of CBS was found to be 9.0% (45/500). Using a binary logistic regression model, correlations were found between older age (p=0.004), longer follow-up time (p=0.040), PPI use (p=0.021), poor visual acuity (p=0.012) and the development of CBS. The increased risk for visual hallucinations caused by PPIs was independent of age (p=0.312), visual acuity (p=0.887) and duration of follow-up (p=0.671). For this model, the area under the curve was 0.772.

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.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.