Recent advances in medical care have made it possible for many people with HIV to live longer, healthier and happier lives.
With increasing and more stable T-cell counts, severe eye problems like cytomegalovirus (CMV) retinitis are less common. In this article we review some of the more common problems for patients with HIV, beginning with the least serious and ending with the most severe.
Our goal is to re-awaken the community to the need for continued eye care. This may help preserve your sight.
Some Common Problems
The first three problems -- dry eye, blepharitis and presbyopia -- are not unique to HIV-positive individuals. They are, however, so common that they should be described.
Dry eyes are the most common problem with HIV patients. The simple condition is rarely serious and can be treated in most cases with artificial tears.
In some patients, dry eyes may increase the risk of a serious eye infection. Sharp pains, intermittent blurred vision (which usually goes away when you blink), and mild irritation are all signs of dry eye. Dry eye symptoms may become worse while using the computer; blink frequently and use extra tears if your eyes become "tired" or irritated.
Blepharitis often goes along with dry eyes and means "inflammation of the eyelids and lashes." Many patients with blepharitis also have mild infection with bacteria, most commonly staph aureus. There may be a discharge and redness of the eye or eyelids. Patients with HIV may get this more often, perhaps due to their weaker immune system, allowing bacteria to grow more easily.
The treatment consists of cleaning your eyelashes using a warm washcloth and a small amount of baby shampoo and warm tap water. The soap should be washed off and a hot compress applied. In some cases, ointments may be needed. See your eye doctor as soon as possible if your vision is blurred, if there is pain or frequent discharge.
Presbyopia is a big word that means a loss of accommodation (difficulty in reading) with aging. This occurs when the lens of the eye becomes less flexible with age and becomes harder to focus up close.
This may begin as early as 35-40 years of age and increases if you are ill or fighting an infection. Reading glasses or bifocals will solve the problem. If you are having trouble reading, ask your doctor if glasses may help.
|The interior of the human eye|
The most serious eye problem in patients with HIV involves the retina.
The eye is like a camera and the retina is the film of the camera lying inside and against the back of the eye. Without the film you cannot see.
CMV infects the retina and is the most common infection and cause of visual problems in patients with AIDS. Most patients that get CMV have T-cell counts below 100.
All patients with HIV should be screened for CMV. The lower your T-cell count the more often you should be seen. If your T-cell count has been low and has been raised, you still need to be followed carefully. If you have floaters, flashing lights or your vision becomes blurry or lose peripheral vision, you should consult your eye doctor right away.
While CMV has become less common than a few years ago, it may be on the rise.
Ganciclovir (GCV) is the most common medicine used to treat CMV retinitis. The Ganciclovir implant is the most common way the drug is delivered to the back of the eye. Placing the Ganciclovir implant, unfortunately, involves a small painless operation. More recently, a long acting pro-drug of Ganciclovir was developed.
We are proud that we helped do the clinical research for Valganciclovir. This new drug allows patients to take a few pills a day instead of having surgery or an intravenous medication. The drug also treats both eyes and the entire body at the same time. The determination of which treatment is better depends on your ocular and clinical condition and your overall health, including your kidney function and anemia. The decision of which is the best method of treatment for you will be based on your eye doctor and your infectious disease or HIV specialists discussing your specific condition.
Other infections can also lead to blindness. Toxoplasmosis, cryptococcus and syphilis have all been seen in patients with HIV.
|Amsler Grid Test|
|Check your vision every day, one eye at a time. Look at the dot in the center. If there are distorted, broken or missing lines notify your eye doctor or contact Retina-Vitreous Associates Medical Group in Los Angeles at (213) 483-8810.|
Syphilis is the second most common infection in patients with HIV. Syphilis can cause almost any eye problem. All HIV-positive patients should be checked for syphilis with a blood test every year. Treatment can save your vision and your life.
Another serious infection is called Progressive Outer Retinal Necrosis, or PORN. PORN is a retinal infection that can quickly destroy the retina (the film of the camera). PORN is caused by a herpes virus, either simplex or zoster. Since it can move quickly, any significant blurring of vision or loss of peripheral or central vision should be reported immediately.
Many of the above infections at the back of the eye can lead to a retinal detachment. If you see floaters, flashing lights or lose some of your sight or peripheral vision, call your eye doctor right away. With surgery, we can anatomically reattach your retina between 90 and 95 percent of the time.
While HAART and other immune recovery therapy have improved the health of our patients, new conditions have developed. The revved-up immune system can react against the HIV infection and cause inflammation in the eye called "immune recovery uveitis." This inflammation may be mild or severe and can cause loss of sight. Fortunately, this condition is very treatable with anti-inflammatory eye drops or medication placed around the eye.
You should check your own vision, one eye at a time, every day. The chart above is an excellent way to check your central vision. You should also check your peripheral vision.
If you see a change, let your eye doctor know right away. The earlier you are seen, the better chance you have to improve or stabilize your vision.
| ||Ron P. Gallemore, M.D., Ph.D. (left) and David S. Boyer, M.D. (right) are in private practice with the Retina-Vitreous Associates Medical Group in Los Angeles and Clinical Faculty at the Jules Stein Eye Institute, UCLA School of Medicine, and Doheny Eye Institute, Keck School of Medicine, respectively. They may be reached by telephone at (213) 483-8810 or via e-mail at RetinaLA@aol.com.|