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C.D. Brodrick, D.J. Skiest, Y. He; To Screen or Not to Screen, Can Symptoms Answer the Question: How Efficient is Routine Screening for CMV Retinitis in the HAART Era? . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3128.
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Purpose: 1. To compare the strategy of routine ophthalmologic screening for CMV-Retinitis (CMV-R) in HIV-infected patients in the HAART era to a symptom oriented screening approach in terms of sensitivity and specificity. 2. To determine the prevalence of eye symptoms in patients subsequently diagnosed with CMV-R compared to those not diagnosed with CMV-R (sensitivity and specificity). 3. To compare the initial eye findings, including zone of retinal involvement in patients with CMV-R between those with and without ocular symptoms. 4. To evaluate the cost effectiveness of routine ocular screening for CMV-R with a symptom oriented approach. Methods: IRB approval was obtained for a prospective study of 126 consecutively examined HIV patients at the Parkland eye clinic from October 2001 until May 2002. A standardized form with a checkbox format was used to collect subjective patient data. Preliminary information included the reason for visit and documentation of any new ocular symptoms. New symptoms included blurred vision, floaters, flashes, visual field defect, eye pain or redness, and photophobia. All patients received a complete ophthalmic examination including slit lamp biomicroscopy and a dilated fundus examination with an indirect ophthalmoscope. The presence of CMV-R was assessed and a detailed drawing was made of retinal findings. Patients with new ocular symptoms were compared to routine visit patients and analysis was made to determine which symptoms were statistically significant. Results: 122 screening visits were performed on HIV patients over an 8 month period. 72% were symptom free at the time of examination. Of the 34 patients with new ocular symptoms, 18% had CMV-R compared to 1.4% of asymptomatic patients. The symptoms of visual field defect and flashes, along with retinal hemorrhages on examination were the most significant predictors of disease. Screening based on our symptom-oriented approach has a detection rate of 86% for CMV-R. Conclusions: A symptom oriented screening approach is both efficient and effective for the evaluation of CMV-R in HIV patients in the HAART era.
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