title: Routine Eye Screening by an Ophthalmologist Is Clinically Useful for HIV-1-Infected Patients with CD4 Count Less than 200 /μL.
abstract: OBJECTIVE
  To investigate whether routine eye screening by an ophthalmologist in patients with HIV-1 infection is clinically useful.
  
  
  METHODS
  A single-center, retrospective study in Tokyo, Japan. HIV-1-infected patients aged over 17 years who visited our clinic for the first time between January 2004 and December 2013 and underwent full ophthalmologic examination were enrolled. At our clinic, ophthalmologic examination, including dilated retinal examination by indirect ophthalmoscopy was routinely conducted by ophthalmologists on the first visit. The prevalence of ophthalmologic diseases and associated factors including the existence of ocular symptoms were analyzed.
  
  
  RESULTS
  Of the 1,515 study patients, cytomegalovirus retinitis (CMV-R) was diagnosed in 24 (2%) patients, HIV retinopathy (HIV-R) in 127 (8%), cataract in 31 (2%), ocular syphilis in 4 (0.3%), and uveitis with unknown cause in 8 (0.5%). Other ocular diseases were diagnosed in 14 patients. The CD4 count was <200 /μL in all CMV-R cases and 87% of HIV-R. The prevalence of any ocular diseases, CMV-R, and HIV-R in patients with CD4 <200 /μL were 22%, 3%, and 15%, respectively, whereas for those with CD4 ≥200 /μL were 5%, 0%, and 2%, respectively. No ocular symptoms were reported by 71% of CMV-R cases and 82% of patients with any ocular diseases.
  
  
  CONCLUSIONS
  Routine ophthalmologic screening is recommended for HIV-1-infected patients with CD4 <200 /μL in resource-rich settings based on the high prevalence of ocular diseases within this CD4 count category and because most patients with ocular diseases, including those with CMV-R, were free of ocular symptoms.
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishijima
authors.affiliation: Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Shigeko
authors.initials: S
authors.lastname: Yashiro
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Teruya
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Naomichi
authors.initials: N
authors.lastname: Katai
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Gatanaga
mesh_terms: D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D017726:Cytomegalovirus Retinitis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005128:Eye Diseases / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009885:Ophthalmology; D015995:Prevalence; D012189:Retrospective Studies; D015351:Vision Screening