VISUAL DYSFUNCTION IN HIV-POSITIVE PATIENTS WITHOUT INFECTIOUS RETINOPATHY

Persons with HIV disease are susceptible to various manifestations of retinal damage, such as infectious retinopathies (e.g., cytomegaloviru s [CMV] retinitis and toxoplasmosis) and noninfectious complications ( microangiopathic infarctions or cotton-wool spots [CWS]); CWS being qu ite common in AIDS patients. Until recently, little research focused o n noninfectious ocular pathology in HIV disease. These disorders may a ll affect normal functioning of the visual system while funduscopic ex amination results appear normal. A review of the psychophysical change s, color and contrast sensitivity, peripheral visual function, electro physiologic and morphologic changes, the relationship of vision loss a nd neuropsychological changes, postretinal damage, and imaging capabil ities cast important new light on quality of life issues and vision fu nction for all HIV/AIDS patients regardless of CD4 count, other measur es of wellness, or treatment protocols. Entopic perimetry, a low-cost psychophysical technique screening test, allows sensitive and specific identification of very peripheral areas of visual field loss. The aut hors recommend its implementation and use by primary care providers, p articularly for early detection of retinal damage when funduscopic exa mination results may appear normal.