Abstract
Purpose The principal objective was to test the hypothesis that HIV-positive patients have significantly reduced amplitudes of accommodation compared with controls. The secondary objective was to investigate accommodative impairment in relation to factors such as age of susceptibility, CD4 count, viral load and current antiretroviral therapies.
Method The study was a single-center open prospective study involving a subject population of 43 HIV-positive men aged from 26 to 39 years with no previous history of eye problems and 21 age-matched healthy male controls. The main outcome measure was the amplitude of accommodation, as measured monocularly with a standard push-up technique.
Results Amplitudes of accommodation were significantly smaller in the HIV-positive group compared with controls for age groups 25-29 (p = 0.016) and 30-34 years (p = 0.030) but not in the older group. In total, 30% (8/27) of patients aged between 25 and 34 years had reduced amplitudes of accommodation below age-expected norms. Accommodative failure was not related to current or lowest CD4 count, viral load or specific antiretroviral therapies.
Conclusion This study has identified accommodative failure in a significant proportion of HIV-positive patients aged between 26 and 35 years. This problem may be under-recognised, and further studies are warranted to investigate possible causes.
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References
Newsome DA . Noninfectious ocular complications of AIDS. Int Ophthalmol Clin 1989;29:95–7.
Wu P, Williams JG, Phillips BJ, Khanna A, Friedlander SM, Goldstein DA . Loss of accommodative amplitude in aids patients. Invest Ophthalmol Vis Sci 1997;38 (Suppl):1101.
Thierfelder S, Mellinghoff-Kreplin G, Hasenfratz G . Clinical studies of reduced accommodation in patients with HIV-1 infection. Klin Monatsbl Augenheilkd 1994;204:523–6.
AIDS-indicator conditions diagnosed in patients reported in 1996, by age group. United States: HIV/AIDS Surveillance Report, Center for Disease Control, Atlanta 1997:8:18.
Hogg RS, O'Shaughnessy MV, Gataric N, Yip B, Craib K, Schechter MT, et al. Decline in deaths from AIDS due to new antiretrovirals [letter]. Lancet 1997;349:1294.
Mitchell SM, Membrey WL, Youle MS, Obi A, Worrell S, Gazzard BG . Cytomegalovirus retinitis after the initiation of highly active antiretroviral therapy: a 2 year prospective study. Br J Ophthalmol 1999;83:652–5.
Walsh JC, Jones CD, Barnes EA, Gazzard BG, Mitchell SM . Increasing survival in AIDS patients with cytomegalovirus retinitis treated with combination antiretroviral therapy including HIV protease inhibitors. Aids 1998;12:613–8.
Pawelski WJ, Gliem H . The accommodation range in diabetics. Ophthalmologica 1971;163:216–26.
Atchison DA . Accommodation and presbyopia. Ophthalmic Physiol Opt 1995;15:255–72.
Hess C . Arbeiten aus dem Gebiete der Accommodationslehre. Graefes Arch Klin Exp Ophthalmol 1901;52:143–74.
Fisher RF . The force of contraction of the human ciliary muscle during accommodation. J Physiol (Lond) 1977;270:51–74.
Tumminia SJ, Jonak GJ, Focht RJ, Cheng YS, Russell P . Cataractogenesis in transgenic mice containing the HIV-1 protease linked to the lens alpha A-crystallin promoter. J Biol Chem 1996;271:425–31.
Bettelheim FA, Churchill AC, Siew EL, Tumminia SJ, Russell P . Light scattering and morphology of cataract formation in transgenic mice containing the HIV-1 protease linked to the lens alpha A-crystallin promoter. Exp Eye Res 1997;64:667–74.
Duane A . Studies in monocular and binocular accommodation with their clinical applications. Am J Ophthalmol 1922;5:865–77.
Duane A . Are the current theories of accommodation correct? Am J Ophthalmol 1925;8:196–202.
Welby SB, Rogerson SJ, Beeching NJ . Autonomic neuropathy is common in human immunodeficiency virus infection. J Infect 1991;23:123–8.
Becker K, Gorlach I, Frieling T, Haussinger D . Characterization and natural course of cardiac autonomic nervous dysfunction in HIV-infected patients. Aids 1997;11:751–7.
Freeman R, Roberts MS, Friedman LS, Broadbridge C . Autonomie function and human immunodeficiency virus infection. Neurology 1990;40:575–80.
Maclean H, Dhillon B . Pupil cycle time and human immunodeficiency virus (HIV) infection. Eye 1993;7:785–6.
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Westcott, M., Ward, M. & Mitchell, S. Failure of accommodation in patients with HIV infection. Eye 15, 474–478 (2001). https://doi.org/10.1038/eye.2001.158
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DOI: https://doi.org/10.1038/eye.2001.158