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.