Eye and Vision Health in aging adults living with or at risk of HIV infection

Abstract

Purpose : In the US, 1 in 6 people are 65 years and over, representing ages at which vision loss and eye disease become increasingly common impacting functionality and quality of life, can be particularly challenging for aging adults with comorbidities and medical complexity, such as adults aging with HIV (AAWH). Here, we present the state of vision health, eye pathology, and access to vision care in aging adults at risk or living with HIV.

Methods : Participants aged 60 years and older from September 2021 to September 2023 from the Baltimore/Washington area. To achieve balance on age across AAWH and participating adults aging without HIV (AAWOH), we used exact matching on age at visit with weighting. Visual function was captured using: backlit Early Treatment of Diabetic Retinopathy Study chart (distance visual acuity [VA]); MNRead chart (near VA); and Nidek ARK 560A Autorefractor (refractive error). Prevalence of eye disease burden and VA impairment (VA worse than 20/40) were estimated.

Results : We recruited 135 participants (87% male; 35% Black; 53% AAWH of whom 97% had a suppressed viral load) with a mean age of 68 years. From the ocular exam, all participants had developed lens opacity or had cataract removed, 3% had retinitis, and 3% had age-related macular degeneration. Differences between AAWH to AAWOH were notable in signs of tear insufficiency by Schirmer’s II test (55% vs. 51%), Meibomian gland dysfunction (19% vs 8%) and conjunctival congestion (10% vs. 4%). AAWH were less likely to have signs of glaucomatous optic neuropathy (19% vs. 28%), but slightly higher prevalence of high IOP (6% vs. 3%). From OCTA imaging, signs of retinal health didn’t differ by HIV status; mean nerve fiber layer thickness was 88 µm and the mean area of the foveal avascular zone was 0.3 mm². For vision function, overall prevalence of distance and near VA impairment was 3% and 6%, respectively, with AAWH having a higher prevalence of both (4% and 8%). Regarding vision care access, 85% of participants reported having an eye doctor (82% among AAWH).

Conclusions : In this sample, we found high prevalence of signs of dry eye disease and signs of glaucoma, with dry eye far more common in AAWH. Prevalence of VA impairment was similar to the general population, though slightly higher in AAWH.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.