Optic Nerve Head Morphology and Visual Field Function in Patients with AIDS and without Infectious Retinitis

Department of Ophthalmology, University of California San Diego, Jacobs Retina Center at Shiley Eye Center , La Jolla, California , USA.
Ocular immunology and inflammation (Impact Factor: 1.44). 06/2012; 20(5):342-8. DOI: 10.3109/09273948.2012.694552
Source: PubMed

ABSTRACT Purpose: To evaluate morphology of the optic nerve head and visual field in AIDS patients without retinitis. Methods: One randomly selected eye from 246 patients with AIDS without retinitis was evaluated from prospective multicenter Longitudinal Studies of Ocular Complications of AIDS. Stereo fundus photographs of OHN and serial VF data over 5-years were analyzed. Main outcomes included vertical cup-to-disc ratio (CDR), mean deviation, and pattern standard deviation scores on VF testing. Results: The median CDR was 0.39 at enrollment and 0.40 at 5-year follow-up. An unadjusted linear regression model revealed a mean change in CDR of 0.004 after 5-years (P = 0.04). After adjustment for practice effect, there were no statistically significant changes in VF performance observed during the 5 years of follow-up. Conclusions: We detected clinically minimal, but statistically significant changes in ONH morphology and no change in VF performance among eyes of patients with AIDS and without retinitis.

Download full-text


Available from: Jennifer E Thorne, Jan 10, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Early Manifest Glaucoma Trial (EMGT) will evaluate the effectiveness of reducing intraocular pressure (IOP) in early, previously untreated open-angle glaucoma. Its secondary aims are to explore factors related to glaucoma progression and to study the natural history of the disease. This article describes the EMGT design and presents baseline data. Randomized, clinical trial. Newly diagnosed patients 50 to 80 years of age with early glaucomatous visual field defects were mainly identified from a population-based screening of more than 44,000 residents of Malmö and Helsingborg, Sweden. Exclusion criteria were advanced visual field loss; mean IOP greater than 30 mmHg or any IOP greater than 35 mmHg; visual acuity less than 0.5; and inability to complete follow-up protocols. After informed consent, patients were randomized to treatment or no initial treatment with close follow-up. Treated patients had laser trabeculoplasty and started receiving topical betaxolol twice daily in eligible eyes. Follow-up visits include computerized perimetry and tonometry every 3 months and fundus photography every 6 months. Decisions to change or begin treatment are made jointly with the patient when EMGT progression occurs and also later if clinically needed. The EMGT progression is defined by sustained increases of visual field loss in three consecutive C30-2 Humphrey tests, as determined from computer-based analyses, or by optic disc changes, as determined from flicker chronoscopy and side-by-side comparisons of fundus photographs performed by masked, independent graders. A total of 255 patients were randomized between 1993 and 1997 and will be followed for at least 4 years. All had generally good health status; mean age was 68.1 years, and 66% were women. At baseline, mean IOP was 20.6 mmHg and 80% of eyes had IOP less than 25 mmHg. The Early Manifest Glaucoma Trial is the first large randomized, clinical trial to evaluate the role of immediate pressure reduction, as compared to no initial reduction, in patients with early glaucoma and normal or moderately elevated IOP. Its results will have implications for: (1) the clinical management of glaucoma; (2) understanding the role of IOP and the natural history of glaucoma; and (3) evaluating the rationale for glaucoma screening.
    Ophthalmology 12/1999; 106(11):2144-53. · 6.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the prevalence and risk factors for vision loss in patients with clinical or immunologic AIDS without infectious retinitis. A prospective, multicenter cohort study of patients with AIDS. One thousand three hundred and fifty-one patients (2,671 eyes) at 19 clinical trials centers diagnosed with AIDS but without major ocular complications of HIV. Standardized measurements of visual acuity, automated perimetry, and contrast sensitivity were analyzed and correlated with measurements of patients' health and medical data relating to HIV infection. We evaluated correlations between vision function testing and HIV-related risk factors and medical testing. There were significant (P<.05) associations between measures of decreasing vision function and indices of increasing disease severity, including Karnofsky score and hemoglobin. A significant relationship was seen between low-contrast sensitivity and decreasing levels of CD4+ T-cell count. Three percent of eyes had a visual acuity worse than 20/40 Snellen equivalents, which was significantly associated with a history of opportunistic infections and low Karnofsky score. When compared with external groups with normal vision, 39% of eyes had abnormal mean deviation on automated perimetry, 33% had abnormal pattern standard deviation, and 12% of eyes had low contrast sensitivity. This study confirms that visual dysfunction is common in patients with AIDS but without retinitis. The most prevalent visual dysfunction is loss of visual field; nearly 40% of patients have some abnormal visual field. There is an association between general disease severity and less access to care and vision loss. The pathophysiology of this vision loss is unknown but is consistent with retinovascular disease or optic nerve disease.
    American Journal of Ophthalmology 03/2008; 145(3):453-462. DOI:10.1016/j.ajo.2007.10.013 · 4.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To characterize retinal changes in areas of cotton wool spots (CWSs) using optical coherence tomography (OCT) and to determine the optical density changes of the retina after CWSs have disappeared clinically. Prospective, noninterventional, observational study. Thirty-one patients with CWSs who underwent imaging studies. The study groups included patients with CWSs resulting from diabetic retinopathy (n = 12), human immunodeficiency virus (HIV) retinopathy (n = 10), hypertensive retinopathy (n = 3), branch retinal vein occlusion (n = 3), uveitis (n = 2), and radiation retinopathy (n = 1). The single line scan mode of the StratusOCT Model 3000 (Carl Zeiss Meditec, Dublin, CA) was used for imaging of acute CWSs, CWSs 3 months after their resolution, and adjacent normal retina. A fundus photograph served as a template for localization of OCT scanning of CWSs. Retinal tissue reflectivity images were compared across lesion types and time. Additional imaging in 14 patients was performed to localize lesions better and to provide coronal OCT sections using the combined OCT and scanning laser ophthalmoscope. Changes in retinal reflectivity in areas of normal retina and retina with acute and resolved CWSs. The average reflectivity of normal retina was 58.4+/-2.1 dB, the average reflectivity in the area of active CWSs was 62.6+/-2.5 dB, and the average reflectivity in the same area after CWSs resolved was 61.0+/-2.4 dB. A significant difference (P<0.05) exists between reflectivity of normal retina and acute CWSs as well as normal retina and resolved CWSs. Acute CWSs show a hyperreflective pattern on OCT. As they become ophthalmoscopically invisible, the OCT still shows signs of hyperreflectivity in the areas of previous CWSs (hyperreflective sign). The authors observed the same phenomenon using 2 imaging machines.
    Ophthalmology 03/2007; 114(3):537-43. DOI:10.1016/j.ophtha.2006.06.054 · 6.17 Impact Factor