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Clinical Sciences
June 1999

Pattern of Early Visual Field Loss in HIV-Infected Patients

Author Affiliations

From the Department of Ophthalmology (Drs Sample, Plummer, Mueller, and Freeman and Ms Matsubara) and HIV Neurobehavioral Research Center (Dr Grant), University of California, San Diego, La Jolla; and Doheny Eye Institute (Dr Sadun), University of Southern California, Los Angeles. The authors have neither financial interest in nor received any payment associated with any device, drug, or instrument mentioned in this article.

Arch Ophthalmol. 1999;117(6):755-760. doi:10.1001/archopht.117.6.755

Objective  To determine the topographic pattern of visual field loss, if any, and its relationship to the stage of disease in human immunodeficiency virus–positive patients without infectious retinopathy.

Methods  A total of 151 eyes from 81 alert and cooperative patients with human immunodeficiency virus were evaluated with visual field testing. Results were analyzed relative to the associated underlying nerve fiber layer patterns associated with retinal ganglion cell axons as they traverse the retina to the optic nerve. The stage of visual field loss was analyzed relative to the length of survival using Kaplan-Meier survival analysis.

Results  No correlation of CD4 cell count with visual field mean defect (r2=0.23) or corrected pattern standard deviation (r2=0.00) was found. A pattern of visual field loss, consistent with sparing of the papillomacular bundles and associated with damage primarily to the inferior retina external to the posterior pole, was found. Survival analysis indicated a significant difference in time of survival between individuals with normal visual fields and those with a diffuse visual field loss, with a trend to less survival with increasing field loss severity.

Conclusions  These results are consistent with disease at the level of the optic nerve. The relationship of stage of visual field loss to survival has important implications for early detection of field loss and appropriate therapeutic intervention to maintain function and quality of life.