Eye Problems

People with HIV infection do not usually have problems with their eyes, and when they do, the problems are often the usual ones that accom­pany the aging process. But there are some eye problems that indicate serious complications, and a physician must be notified.

Blurred Vision

Blurred vision, along with several other symptoms and a low CD4 cell count, may indicate an infection of the eye called cytomegalovirus (CMV) retinitis. In addition to blurred vision, symptoms of CMV re­tinitis can include a blind spot, pain in the eye, and “floaters.” Floaters are spots that float across the line of vision as a result of inflamed cells in the middle of the eye. In many instances the person with CMV re­tinitis notices no symptoms at all.

In this case, CMV has infected the retina, the layer of cells in the back of the eye that, like the film of a camera, is responsible for record­ing images. The specific symptoms a person has will depend on which area of the retina is affected. CMV retinitis used to occur in 20 to 30 percent of people with HIV infection, but with HAART, the number of cases has decreased by 80 percent. CMV retinitis is now quite infrequent; it virtually never occurs when the CD4 cell count is over 100 and usu­ally occurs when it is less than 50. For people with CD4 counts below 50, many physicians recommend a routine ophthalmologic examination at six-month intervals.

CMV retinitis can occur in one eye or in both eyes. If the infection in one eye is left untreated, it will often affect the other eye as well. If both eyes are infected and left untreated, the usual result is blindness. Loss of sight caused by cytomegalovirus cannot be corrected with glasses.

With early treatment, vision can usually be saved before blindness occurs. Options for treatment are now extensive. They include a drug, ganciclovir, which can be taken by mouth (Valcyte), by vein (Cytovene), or by a device (Vitrasert) that is implanted in the eye by an ophthalmol­ogist and that slowly releases ganciclovir for six months. All options will temporarily stop or slow the progression of the retinitis; that is, the re­tinitis will get no worse. None, however, will reverse the damage already done.

Treatment is continued until people take HAART and have a re­bound in their CD4 cell counts; the reconstituted immune system pro­tects against progression of CMV retinitis. But treatment will need to start again if the CD4 count goes below 100.

CMV retinitis is now a disappearing disease. Essentially all of the infectious disease-complications of HIV are decreasing in frequency be­cause of HAART, but CMV retinitis has decreased more than any of the others.