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Risk of Loss of Visual Acuity for Patients With AIDS

¹ Ophthalmology, University of Pennsylvania, Philadelphia, PA
^A Ophthalmology, ^B Epidemiology, ² Johns Hopkins University, Baltimore, MD

Commercial Relationships: J.H. Kempen, None; J.E. Thorne, None; J.T. Holbrook, None; D.A. Jabs, None; C.W. Nichols, None; C.L. Meinert, None.

Support: NIH Cooperative Agreements U10 EY08052, U10 EY08057, and U10 EY08067

Abstract

Purpose: To evaluate: 1) the risk of reduction in visual acuity for patients with the Acquired Immune Deficiency Syndrome (AIDS) who are initially free of cytomegalovirus (CMV) retinitis; 2) potential risk factors for such vision loss; and 3) the causes of observed vision loss in this group.

Methods: Participants included 1283 patients (2566 eyes) with AIDS enrolled in the Longitudinal Study of Ocular Complications of AIDS, who had at least one follow–up visit on record as of December 31, 2003, and were free of CMV retinitis at the time of enrollment. Best–corrected logarithmic visual acuity (VA), medical history, eye examination, and laboratory testing were obtained at enrollment and semi–annually thereafter. Events studied were reduced VA to 20/50 or worse and to 20/200 or worse, and incidence of loss of three lines of VA (doubling of the visual angle). Potential risk factors for these events, and observed causes of vision loss also were studied.

Results: Among 2566 eyes of 1283 patients, 3.6% and 1.6% had best–corrected visual acuity of 20/50 or worse and of 20/200 or worse at the time of enrollment. Incidence rates––for doubling of the visual angle, for loss of VA to 20/50 or worse, and for loss of VA to 20/200 or worse––were 3.3%/eye–year (EY), 1.7%/EY, and 0.9%/EY respectively. A Karnofsky score of 80 or worse and a CD4+ T cell count less than 50 cells/µL at enrollment were associated with a higher incidence of vision loss. Approximately 40% of incident loss of VA was attributable to incidence of CMV retinitis and its sequelae, and approximately 25% of incident loss of VA was attributable to incidence of cataract.

Conclusions: The risk of loss of VA appears to be substantially higher among patients with AIDS who do not (initially) have CMV retinitis than for persons of similar age in the general population. Risk factors for loss of VA include more severe immunodeficiency and poorer general health status. Although incident CMV retinitis was the most common observed cause of vision loss, incident cataract also was an important cause of vision loss in this group.

Keywords: AIDS/HIV • visual acuity • cytomegalovirus

© 2006, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any part of this abstract, contact the ARVO Office at arvo{at}arvo.org.