Retinal Nerve Fiber and Optic Disc Morphology in Patients with Human Immunodeficiency Virus Using the Heidelberg Retina Tomography 3

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Abstract

Purpose

To use novel confocal scanning ophthalmoscopy technology to test hypothesis that HIV-seropositive patients without history of retinitis with a history of a low CD4 count are more likely to have damage to their retinal nerve fiber layer (RNFL) when compared to patients with high CD4 count. In addition, we compared optic disc morphologic changes with glaucoma.

Design

Cross-sectional study.

Participants and Controls

171 patients were divided into four groups. The control group consisted of 40 eyes of 20 HIV-seronegative patients. The second group consisted of 80 eyes of 41 HIV-positive patients whose CD4 cell count never dropped below 100 (1.0 x 10 ⁹/L). The third group consisted of 44 eyes of 26 HIV-positive patients with a history of low CD4 counts <100. Fourth group consisted of 79 eyes of 79 patients with confirmed glaucoma who served as positive controls.

Testing

Confocal scanning laser ophthalmoscopy was performed with the Heidelberg Retina Tomograph (HRT3) and data were analyzed with HRT3, software (Heyex version 1.5.10.0).

Main Outcome Measures

Disc area, cup area, cup volume, rim volume, mean cup depth, maximum cup depth, cup-to-disc ration, mean RNFL thickness, and RNFL cross-sectional area.

Results

Analysis of the global optic nerve and cup parameters showed no difference in disk area among the four groups. There was also no difference in cup, rim volume, mean cup depth, or maximum cup depth among the first three groups but they were all different from glaucoma group. The RNFL was thinner in glaucoma and both HIV-positive groups compared to HIV-seronegative subjects. The cross sectional RNFL area was thinner in both high and low CD4 HIV-positive groups compared to HIV-seronegative group in the nasal and temporal/inferior sectors, respectively. Glaucoma group showed thinning in all sectors.

Conclusions

HIV retinopathy results in retinal nerve fiber layer loss without structural optic nerve supportive tissue change. RNFL damage may occur early in HIV disease by mechanism different than in glaucoma.

Related collections

Most cited references 34

Record: found
Abstract: found
Article: not found

Changes in the risk of death after HIV seroconversion compared with mortality in the general population.

Krishnan Bhaskaran, Osamah Hamouda, Mette Sannes … (2008)

Mortality among human immunodeficiency virus (HIV)-infected individuals has decreased dramatically in countries with good access to treatment and may now be close to mortality in the general uninfected population. To evaluate changes in the mortality gap between HIV-infected individuals and the general uninfected population. Mortality following HIV seroconversion in a large multinational collaboration of HIV seroconverter cohorts (CASCADE) was compared with expected mortality, calculated by applying general population death rates matched on demographic factors. A Poisson-based model adjusted for duration of infection was constructed to assess changes over calendar time in the excess mortality among HIV-infected individuals. Data pooled in September 2007 were analyzed in March 2008, covering years at risk 1981-2006. Excess mortality among HIV-infected individuals compared with that of the general uninfected population. Of 16,534 individuals with median duration of follow-up of 6.3 years (range, 1 day to 23.8 years), 2571 died, compared with 235 deaths expected in an equivalent general population cohort. The excess mortality rate (per 1000 person-years) decreased from 40.8 (95% confidence interval [CI], 38.5-43.0; 1275.9 excess deaths in 31,302 person-years) before the introduction of highly active antiretroviral therapy (pre-1996) to 6.1 (95% CI, 4.8-7.4; 89.6 excess deaths in 14,703 person-years) in 2004-2006 (adjusted excess hazard ratio, 0.05 [95% CI, 0.03-0.09] for 2004-2006 vs pre-1996). By 2004-2006, no excess mortality was observed in the first 5 years following HIV seroconversion among those infected sexually, though a cumulative excess probability of death remained over the longer term (4.8% [95% CI, 2.5%-8.6%] in the first 10 years among those aged 15-24 years). Mortality rates for HIV-infected persons have become much closer to general mortality rates since the introduction of highly active antiretroviral therapy. In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens.

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Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss.

Cheryl N Miller, Marc A. Sommer, Donald Robin … (1990)

Standardized perimetry and nerve fiber layer and color fundus photography were performed annually on 1344 eyes with elevated intraocular pressures. In 83 eyes, glaucomatous field defects developed that met rigid criteria on manual kinetic and suprathreshold static perimetry. Individual nerve fiber layer photographs were read by two masked observers. The more sensitive of the two identified nerve fiber layer defects in 88% of readable photographs at the time field loss first occurred; 60% (6/10) of eyes already had nerve fiber layer defects 6 years before field loss. In contrast, the nerve fiber layer was considered abnormal in only 11% (3/27) of normal eyes and 26% (84/327) of hypertensive eyes. The location of nerve fiber layer and field defects closely corresponded, but nerve fiber layer loss was generally more widespread. Examiner experience and severity of optic nerve damage influenced results. Mild focal defects were more readily recognized than more severe diffuse atrophy. Nerve fiber layer defects expanded with time, often by the development and coalescence of adjacent areas of damage.

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Retinal nerve fibre layer loss in patients with type 1 diabetes mellitus without retinopathy.

V. Costa, Tiffany H. Russ, M Ponz (2002)

There is evidence suggesting the occurrence of neurovisual abnormalities in patients with diabetes without retinopathy. However, the determination of abnormalities in the neural and glial elements in vivo is difficult. The aim of this study was to investigate whether a retinal nerve fibre layer (RNFL) defect (as determined by scanning laser polarimetry, SLP) is present in patients without clinical manifestations of diabetic retinopathy. 12 patients with type 1 diabetes mellitus (DM) without retinopathy or other diabetes induced microvascular complications, underwent a complete ophthalmological examination, including automated perimetry and RNFL measurements with a nerve fibre layer analyser GDx. The data were compared with a normal control group matched for age and sex. The superior segment retardation in patients with diabetes was lower than in the control group, based on the superior integral (0.19 (SD 0.06) v 0.23 (0.04) mm(2), p=0.03) and the superior average (71.0 (11.05) v 84.27 (10.56) microm, p=0.007) parameters. This finding may be indicative of significant nerve fibre loss in the superior segment of the retina in patients with type 1 diabetes mellitus but without retinopathy. The meaning of intraretinal differences in RNFL retardation, indicating asymmetric NFL loss, in patients with diabetes is yet not understood.

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Author and article information

Contributors

Ted S Acott: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 10 August 2015

Publication date Collection: 2015

Volume: 10

Issue: 8

Electronic Location Identifier: e0133144

Affiliations

[1 ]Jacobs Retina Center at the Shiley Eye Institute, University of California San Diego, La Jolla, California, United States of America

[2 ]HIV Neurobehavioral Research Center (HNRC), San Diego, California, United States of America

[3 ]Retina Associates of Utah, Salt Lake City, Utah, United States of America

[4 ]Hamilton Glaucoma Center at the Shiley Eye Institute, University of California San Diego, La Jolla, California, United States of America

[5 ]Hanyang University, Seoul, South Korea

[6 ]King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia

Casey Eye Institute, UNITED STATES

Author notes

Competing Interests: Drs. Bartsch, Freeman and Weinreb declare that they have received instruments for use in research from Heidelberg Engineering at reduced cost. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Conceived and designed the experiments: DUB IK WRF. Performed the experiments: IK VLK BRL. Analyzed the data: DUB IK RNW WRF. Contributed reagents/materials/analysis tools: IG. Wrote the paper: DUB IK RNW WRF.

* E-mail: dbartsch@ 123456ucsd.edu

Article

Publisher ID: PONE-D-14-01065

DOI: 10.1371/journal.pone.0133144

PMC ID: 4530938

PubMed ID: 26258547

SO-VID: 762caeab-1cdc-49dd-b8f9-5fdff451b16d

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 13 January 2014

Date accepted : 23 June 2015

Page count

Figures: 0, Tables: 4, Pages: 9

Funding

Supported in part by National Eye Institute grants R01EY016323 (DUB), R01EY007366 (WRF), and Core Grant for Vision Research (P30EY022589); Research to Prevent Blindness, New York City, NY (Unrestricted grant). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Retinal Nerve Fiber and Optic Disc Morphology in Patients with Human Immunodeficiency Virus Using the Heidelberg Retina Tomography 3

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Abstract

Purpose

Design

Participants and Controls

Testing

Main Outcome Measures

Results

Conclusions

Related collections

PLOS Climate

Most cited references 34

Changes in the risk of death after HIV seroconversion compared with mortality in the general population.

Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss.

Retinal nerve fibre layer loss in patients with type 1 diabetes mellitus without retinopathy.

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