title: Herpes zoster ophthalmicus: declining age at presentation.
abstract: OBJECTIVE
  To investigate changes in the age of occurrence of herpes zoster ophthalmicus (HZO) in patients presenting to the Massachusetts Eye and Ear Infirmary (MEEI) from 2007 through 2013.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Academic tertiary referral centre for ophthalmic conditions.
  
  
  METHODS
  913 patients with acute HZO.
  
  
  METHODS
  A total of 1283 potential cases were identified by searching the MEEI electronic medical record for patient charts with International Classification of Diseases 9 codes for herpes zoster, shingles and varicella from 2007 through 2013. The cases were reviewed to confirm diagnosis of acute HZO, requiring documentation of a skin rash or pain in the V1 distribution, resulting in inclusion of 913 cases.
  
  
  METHODS
  Number of HZO cases each year, mean age of HZO cases each year, number of HZO cases with an immunodeficiency state.
  
  
  RESULTS
  The number of patients with HZO presenting to MEEI increased from 71 cases in 2007 to 195 cases in 2013. The mean age of patients with acute HZO reduced significantly from 61.2 years in 2007 to 55.8 years in 2013 (p=0.0119). The number of patients with acute HZO in the setting of an immunodeficiency state did not change significantly over the study period.
  
  
  CONCLUSIONS
  Ever since the introduction of varicella vaccination in children, there has been debate regarding its effect on zoster epidemiology, particularly regarding the potential to reduce population exposure and limit repeated immunological boosts against varicella zoster virus in adults. Patients presenting to MEEI with HZO were younger on average in 2013 than in 2007. Although a population-based study is necessary to test the hypothesis, our study suggests that varicella vaccination of children remains a possible explanation for the increased number of cases and reduction in mean age of newly diagnosed patients.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Emma C
authors.initials: EC
authors.lastname: Davies
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Pavan-Langston
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: James
authors.initials: J
authors.lastname: Chodosh
mesh_terms: D000208:Acute Disease; D017668:Age of Onset; D000368:Aged; D000375:Aging; D016208:Databases, Factual; D057286:Electronic Health Records / Q000706:statistics & numerical data; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Cornea; Epidemiology; Infection