A number of HIV-related conditions have retinal manifestations, including disseminated tuberculosis, CMV disease, toxoplasmosis, and more. This makes it important that HIV clinicians have some basic skills in fundoscopy and other elements of eye examination. But what’s that you say? You haven’t picked up an ophthalmoscope in a few years?!? Here are a few resources to help you out:
1. Courtesy of David Heiden, an American ophthalmologist who has been supporting MSF for years, a series of 12 self-study lectures are available that can help clinicians to feel more confident in performing an eye examination. These 12 PPTs can be viewed and downloaded from the Eyes folder in the Clinical Resources page.
2. In order to detect HIV-related retinal disease early, it is necessary to screen all at-risk individuals. Fundoscopy should be routinely performed in all those presenting with advanced HIV disease (e.g. CD4 count <100 cells/µL). Practical information on the clinical management of such ‘late presenters’, including some retinal images, can be found here in poster format.
3. Choroidal tubercles are a possible manifestation of disseminated tuberculosis (TB). Point-of-care fundoscopy can assist in rapid diagnosis, thereby reducing the risk of mortality (which is high in such cases). For more information on how retinal examination can help identify disseminated TB, see the following publications:
- Eye exam for the early diagnosis of disseminated TB in patients with AIDS, Lancet ID, Feb 2016.
- Retinal examination can help identify disseminated TB in PLHIV, Clinical Infectious Diseases, Jan 2013.
4. The prevalence of HIV-related cytomegalovirus (CMV) disease and retinitis remains high in low- and middle-income countries, especially those in Asia. Publications that describe both the problem of CMV retinitis and potential solutions for early diagnosis and treatment include:
- The neglected disease of the AIDS pandemic (Heiden)
- The burden of HIV-related CMV retinitis in Resource-Limited Settings (Ford)
- Training clinicians treating HIV to diagnose CMV retinitis (Heiden)
- CMV retinitis screening and treatment in a resource-poor setting (Tun)
5. Some tools that can help you to implement and document a CMV retinitis screening strategy include:
- A template for recording retinal findings
- An Excel sheet that can be used to document a retinal screening strategy
6. Don’t forget to dilate the pupils prior to performing retinal examination. This is essential for optimal visualization of the fundus. Tropicamide is often used in resource-limited settings. Some practical information on the administration of such drops can be found here.
7. Access to a point-of-care device that takes digital retinal images (DRI) would greatly facilitate the implementation of a retinal screening strategy, including use of tele-ophthalmology. Despite having field tested a number of portable devices, including one that incorporates an iPhone ‘app’, we have not yet found a device that is suitable for use by HIV clinicians in resource-limited settings. So the search continues…
8. A 1.5 page summary describing TREATMENT of CMV retinitis in resource-limited settings can be found here.
- Date May 23, 2013
- Tags CMV, HIV, Opportunistic infection (OI), TB