A Correlation of Retinal Lesion Appearance and Distribution to CD4 Counts of Patients with Human Immunodeficiency Virus Using Ultrawide Field Scanning Laser Ophthalmoscope Images
Anna Maria F. Payawal-Lucero, MD1 , Paolo S. Silva, MD2,3
1Eye and Vision Institute, The Medical City, Pasig City, Metro Manila, Philippines
2Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.
3Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
Correspondence: Anna Maria F. Payawal-Lucero, MD
Office Address: Department of Ophthalmology, The Medical City, Ortigas Avenue, Pasig City 1604, Metro Manila, Philippines
Office Number: +6329881000 local 6252
Email Address: annapie.payawal@gmail.com
Disclosure: A.M.F.P.L reports no financial relationship. P.S.S. receives research support from Optomed, Optos, Kubota Vision not related to this paper.
ABSTRACT
Objective: To identify retinal lesions through ultrawide field (UWF) images and correlate their presence, size, location, and number with the immunologic status of individuals living with human immunodeficiency virus (HIV)
Methods: This retrospective study reviewed UWF retinal images and CD4 counts of adult patients diagnosed with HIV. ImageJ software was used to annotate lesions and create heat maps. The distribution of lesions (hemorrhages, cotton wool spots, cytomegalovirus [CMV] lesions) was evaluated across 3 retinal zones: posterior pole, mid-periphery and far periphery. Statistical analyses were conducted using SAS version 9.4.
Results: The study included 44 eyes of 23 male HIV patients, with a mean age of 35 ± 9.3 years, and a mean CD4 count of 74 ± 145 cells/mm³. HIV retinopathy was present in 24 (54.5%) eyes and CMV retinitis in 6 (13.6%) eyes. Among eyes with HIV-related findings (N=30), 8 (26.7%) had hemorrhages, 19 (63.3%) had cotton wool spots, and 7 (23.3%) had both. Eyes with HIV retinopathy had significantly low CD4 counts (17 vs. 25 cells/mm³, p=0.0398), and eyes with CMV retinitis had even lower CD4 counts (9 vs. 22 cells/mm³, p=0.0133). Lesion annotations showed that the mean area covered by hemorrhages was 0.47 mm² (97.9% in the posterior pole), cotton wool spots was 0.73 mm² (96.0% in the posterior pole), and CMV lesions was 22.89 mm² (37.9% in the posterior pole, 35.9% in the mid-periphery, and 26.1% in the far periphery).
Conclusion: HIV retinopathy findings are predominantly located within 10 mm of the foveal center, while over 62% of CMV lesions are present outside this zone. This highlights the importance of evaluating the retinal periphery in high-risk patients. Regular monitoring using UWF imaging is recommended for HIV-infected individuals with low CD4 counts, to detect vision-threatening conditions like CMV retinitis.
Keywords: HIV; HIV retinopathy; CD4+; CMV retinitis; cotton wool spots; retinal hemorrhages; ultrawide field images