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., cytomegalovirus [CMV] retinitis and toxoplasmosis) and noninfectious complications (microangiopathic infarctions or cotton-wool spots [CWS]); CWS being quite common in AIDS patients. Until recently, little research focused on noninfectious ocular pathology in HIV disease. These disorders may all affect normal functioning of the visual system while funduscopic examination results appear normal. A review of the psychophysical changes, color and contrast sensitivity, peripheral visual function, electrophysiologic and morphologic changes, the relationship of vision loss and neuropsychological changes, postretinal damage, and imaging capabilities cast important new light on quality of life issues and vision function for all HIV/AIDS patients regardless of CD4 count, other measures 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 authors recommend its implementation and use by primary care providers, particularly for early detection of retinal damage when funduscopic examination results may appear normal.