Low Vision Rehabilitation of an HIV+ Patient with Retinal Necrosis and Optic Atrophy

Signature Grand, Davie, Florida, USA

Background. Immunosuppression due to Human Immunodeficiency Virus (HIV) can lead to ocular complications from opportunistic agents. Retinal necrosis is a potentially visually devastating consequence of ocular infection in HIV+ patients. Cytomegalovirus retinitis and acute retinal necrosis secondary to herpes simplex virus or Varicella Zoster Virus are the most common causes of retinal necrosis. Infection commonly begins in the peripheral retina and spreads posteriorly, resulting in necrotic retina with a corresponding absolute scotoma. Optic neuropathy is also a common result of infection and may cause additional visual acuity or visual field loss. Significant visual impairment often occurs rapidly, and low vision rehabilitation, including referrals to appropriate services and agencies, is essential for patients to remain independent. Case Summary. A 29-year-old woman was referred to us for a low vision evaluation. She had been diagnosed with HIV approximately two years ago. The patient experienced vision loss five months prior to our evaluation, at which time she was diagnosed with retinal necrosis. Past ocular history was also significant for trauma OS twelve years prior with resulting visual loss. Entering distance visual acuities were 4/20M OD (20/100 Snellen Equivalent) and 2/25M OS (20/250 Snellen Equivalent). Visual field testing showed severe inferior and superonasal restriction OD as well as severe superior and inferonasal restriction OS. Fundus examination revealed extensive necrotic retinal tissue OU, chorioretinal scarring and scleral buckle OS, and marked optic atrophy OU. Based on the patient’s stated goals and her performance with devices during the evaluation, +8.00 D half-eyes were prescribed for reading, a 3X full-field spectacle-mounted telescope with a +3.00 D reading cap was prescribed for computer use and larger-print reading material, and a 4X12 handheld telescope was prescribed for spotting. The patient was referred to the Division of Blind Services for assistance in retaining employment. Additional community services were recommended for transportation and other daily living tasks. Conclusion. The ocular manifestations of HIV can be visually devastating. However, low vision rehabilitation can help patients to effectively use their remaining vision. Referrals to appropriate services and agencies will allow these patients to maintain an independent and productive lifestyle, both financially and personally.