Visual Impairment and Eye Disease in Aging People Living with and without HIV

Abstract

Purpose : Limited data exist regarding vision health in aging people living with HIV (PLWH), who may be at higher risk of intraocular inflammatory disorders that lead to visual impairment (VI). Preliminary investigation of VI and eye disease was conducted among aging PLWH and people without HIV (PWOH) in the MACS WIHS Combined Cohort Study (MWCCS).

Methods : We recruited PLWH and PWOH participants aged 60 years and older from three MWCCS study sites in Baltimore/Washington since September 2021. Participants 77 years and younger were included in the analysis to achieve comparable age distributions between PLWH and PWOH. Vision function assessments and OCT imaging were performed by trained staff and an ophthalmic exam by an ophthalmology fellow. Presenting distance visual acuity (VA) was assessed using a retro-illuminated Early Treatment of Diabetic Retinopathy Study chart in each eye using habitual correction. Contrast sensitivity (CS) was assessed in each eye using the MARS charts. Refraction was assessed using an autorefractor (Nidek ARK560A). Uncorrected refractive error was defined as VA worse than 20/40 and improved to 20/40 or better after refraction. Prevalence of VI (VA worse than 20/40 after refraction or CS worse than 1.50 logCS in the better eye) and eye disease burden were evaluated.

Results : We studied 62 PLWH (97% were virally suppressed with HIV viral load <200 copies/mL) and 51 PWOH, median [IQR] age was 68 [64, 71] years, 31% were Black, and 15% were female. PLWH were more likely to be female (22.6% vs. 5.9%, P=0.01). The prevalence of VA impairment was 3.2% vs. 2.0% for PLWH and PWOH, respectively; for CS impairment it was 3.2% vs. 3.9%, and for uncorrected refractive error it was 12.9% vs. 7.8%. The prevalence of tear insufficiency by Schirmer’s test among PLWH (56.1%) and PWOH (55.1%) was high. All participants had developed some degree of cataract; 24.6% PLWH vs. 15.7% PWOH had cataract surgery. Prevalence of retinopathy (1.8%), retinitis (2.8%), and glaucoma (21.1%) were similar by serostatus groups. Active uveitis was not present in any participant.

Conclusions : The need for eyecare is high among this small sample of PLWH with viral suppression and PWOH. Given that some vision problems like refractive error are correctable and are more common in PLWH, there may be opportunities to intervene through vision screening to improve quality of life in this aging group.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.