Pattern of early visual field loss in HIV-infected patients

Objective: To determine the topographic pattern of visual field loss, if an y, and its relationship to the stage of disease in human immunodeficiency v irus-positive patients without infectious retinopathy. Methods: A total of 151 eyes from 81 alert and cooperative patients with hu man immunodeficiency virus were evaluated with Visual field testing. Result s were analyzed relative to the associated underlying nerve fiber layer pat terns associated with retinal ganglion cell axons as they traverse the reti na 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 (r( 2) = 0.23) or corrected pattern standard deviation (r(2) = 0.00) was found. A pattern of visual field loss, consistent with sparing of the papillomacu lar bundles and associated with damage primarily to the inferior retina ext ernal to the posterior pole, was found. Survival analysis indicated a signi ficant difference in time of survival between individuals with normal visua l fields and those with a diffuse visual field loss, with a trend to less s urvival 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 t herapeutic intervention to maintain function and quality of life.