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Global issues
Visual acuity outcomes in cytomegalovirus retinitis: early versus late diagnosis
  1. Somsanguan Ausayakhun1,
  2. Michael Yen2,3,
  3. Choeng Jirawison4,
  4. Sakarin Ausayakhun1,
  5. Preeyanuch Khunsongkiet1,
  6. Prattana Leenasirimakul5,
  7. Siripim Kamphaengkham5,
  8. Blake M Snyder2,
  9. David Heiden6,
  10. Gary N Holland7,
  11. Todd P Margolis8,
  12. Jeremy D Keenan2,9
  1. 1 Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  2. 2 Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
  3. 3 Icahn School of Medicine at Mount Sinai, New York, USA
  4. 4 Department of Ophthalmology, HIV Center, Nakornping Hospital, Chiang Mai, Thailand
  5. 5 HIV Center, Nakornping Hospital, Chiang Mai, Thailand
  6. 6 Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California, USA
  7. 7 Department of Ophthalmology, University of California, Los Angeles, California, USA
  8. 8 Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
  9. 9 Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Jeremy D Keenan, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA 94143, USA; jeremy.keenan{at}ucsf.edu

Abstract

Aims To determine if early dilated fundus examination for cytomegalovirus (CMV) retinitis leads to better visual outcomes in areas with limited HIV care, where patients may have long-standing retinitis before they are diagnosed with HIV.

Methods Twenty-four eyes of 17 patients with CMV retinitis who were seen at an urban HIV clinic in Chiang Mai, Thailand, were included in this retrospective cohort study. Participants were divided into two groups based on the amount of time from the first documented CD4 count below 100 cells/mm3 to the first eye examination for CMV retinitis. Average visual acuity in each group was calculated at the time CMV retinitis was first detected, and then at 3, 6 and 12 months after diagnosis.

Results The group of patients who received an eye examination within approximately 4 months of the initial low CD4 count measurement had better baseline visual acuity (median 20/30,IQR 20/20 to 20/60) compared with patients who presented later (median 20/80, 20/60 to hand motion); p=0.03). Visual acuity did not change significantly during the 12-month study period in either the early group (p=0.69) or late group (p=0.17).

Conclusion In this study, patients who were examined sooner after a low CD4 count had better vision than patients who were examined later. Routine early screening of patients with CD4 counts under below 100 cells/mm3 may detect earlier disease and prevent vision loss.

  • retina
  • infection

https://doi.org/10.1136/bjophthalmol-2018-312191

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    Footnotes

    • SA and MY contributed equally.

    • Contributors SoA, MY, CJ and JDK designed the study. MY, SaA, PK, PL, BMS and SK collected the data. MY and JDK analysed the data. SoA, MY, CJ, DH, GNH, TPM and JDK interpreted the results. MY wrote the first draft of the manuscript. All authors critically edited the manuscript.

    • Funding This study was supported by That Man May See (San Francisco, CA), the Fortisure Foundation (San Mateo, CA), the JaMel and Tom Perkins Family Foundation (San Francisco, CA), Research to Prevent Blindness, and the Doris Duke Charitable Foundation (New York, NY) through a grant supporting the Doris Duke International Clinical Research Program at the University of California, San Francisco.

    • Competing interests GNH has served on advisory boards for the following companies: Genentech (South San Francisco, CA), Novartis (Basel, Switzerland), Santen (Emeryville, CA) and Xoma (Berkeley, CA). TPM has pending intellectual property with the University of California (Berkeley, CA) describing a mobile phone camera for retinal imaging. At the current time this intellectual property has no financial value.

    • Patient consent Not required.

    • Ethics approval Committee on Human Research at the University of California, San Francisco, and the Institutional Review Boards at Chiang Mai University and Nakornping Hospital, Chiang Mai, Thailand, prior to conducting this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data are reported in the manuscript.