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Am J Psychiatry 1992; 149:1701-1706
Copyright © 1992 by American Psychiatric Association
Visual hallucinations in patients with macular degeneration
S Holroyd, PV Rabins, D Finkelstein, MC Nicholson, GA Chase and SC Wisniewski
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore.
OBJECTIVE: This study was undertaken to determine the prevalence of visual
hallucinations in patients with macular degeneration, describe such
hallucinations phenomenologically, and possibly determine factors
predisposing to their development. METHOD: Using a case-control design, the
authors screened 100 consecutive patients with age-related macular
degeneration for visual hallucinations. Each patient with visual
hallucinations was matched to the next three patients without
hallucinations. The patients and comparison subjects were compared in terms
of scores on the Beck Depression Inventory, Eysenck Personality
Questionnaire, Telephone Interview for Cognitive Status, and a structured
questionnaire including demographic characteristics, family history, and
medical and psychiatric history. Ophthalmologic data were obtained by chart
review. RESULTS: Of the 100 patients, 13 experienced visual hallucinations.
Four variables were significantly associated with having hallucinations:
living alone, lower cognition score, history of stroke, and bilaterally
worse visual acuity. Hallucinations were not associated with family or
personal history of psychiatric disorder or with personality traits. In 11
(84.6%) of the 13 patients, the hallucinations had begun in association
with an acute change in vision. CONCLUSION: These results indicate that
visual hallucinations are prevalent among patients with macular
degeneration. They appear unrelated to primary psychiatric disorder. The
predisposing factors of bilaterally worse vision and living alone support
an association with sensory deprivation, while history of stroke and worse
cognition support a decreased cortical inhibition theory.
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