Abstract
Purpose :
Given the increasing prevalence of syphilis and methamphetamine (meth) use disorder, understanding the potential impact of meth on disease presentation, severity, and visual acuity (VA) warrants further investigation.
Methods :
A retrospective study to investigate the association between meth use and disease severity in patients with ocular syphilis treated at a tertiary referral center from 2021-2022 was performed. Data collected included demographics, VA at baseline, 3- and 6- months, severity of vision impairment, and duration of ocular symptoms prior to presentation. Laterality, optic nerve involvement, and placoid features by clinical exam or imaging were noted. Cases were stratified by presence or absence of meth use. Statistical analyses were used to assess association of meth use with VA impairment, disease presentation, and progression. Chi-squared or Wilcoxon signed-rank test for VA comparisons over time were performed accordingly with a p<0.05 for significance.
Results :
Data for 34 affected eyes of 21 patients with ocular syphilis was reviewed. Fifteen patients (71%) were male and six were female (29%). The median age was 44 years (Range 33-82). Thirteen patients (62%) had bilateral involvement. Thirteen (62%) had optic nerve involvement and four (19%) had placoid features. Median presenting VA was 20/80 and improved to 20/40 at 3 months (p=0.007) with further improvement to 20/30 at 6 months (p=0.030) after treatment. Presenting median VA in eyes within the meth group (N=11) was worse than the non-user group (N=23, 20/200 vs 20/50, p=0.009 for between-group comparison). While the non-meth group exhibited a significant median VA improvement from baseline to 3- and 6-month follow-up (20/50 to 20/30, p=0.006 for 3-month and p=0.017 for 6-month vs baseline), this improvement was not observed in the meth group (20/200 to 20/200, p>0.05). This effect was seen despite earlier presentation from symptom onset in the meth group (1 vs 5.2 weeks in non-meth, p=0.02). Optic nerve involvement and placoid syphilis were greater in the meth cohort but did not achieve significance.
Conclusions :
Meth use was associated with worse baseline VA and while non-users showed VA improvement, VA in the meth group remained unchanged. The role of meth in exacerbating ocular involvement in syphilis, including potentially optic nerve disease, and the pathogenesis of this interaction warrants further study.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.