Pattern of early visual field loss in HIV-infected patients.

Objective: To determine the topographic pattern of visual field loss, if any, and its relationship to the stage of disease in human immunodeficiency virus-positive patients without infectious retinopathy.

Methods: A total of 151 eyes from 81 alert and cooperative patients with human immunodeficiency virus were evaluated with visual field testing. Results were analyzed relative to the associated underlying nerve fiber layer patterns associated with retinal ganglion cell axons as they traverse the retina to the optic nerve. The stage of visual field loss was analyzed relative to the length of survival using Kaplan-Meier survival analysis.

Results: No correlation of CD4 cell count with visual field mean defect (r2 = 0.23) or corrected pattern standard deviation (r2 = 0.00) was found. A pattern of visual field loss, consistent with sparing of the papillomacular bundles and associated with damage primarily to the inferior retina external to the posterior pole, was found. Survival analysis indicated a significant difference in time of survival between individuals with normal visual fields and those with a diffuse visual field loss, with a trend to less survival with increasing field loss severity.

Conclusions: These results are consistent with disease at the level of the optic nerve. The relationship of stage of visual field loss to survival has important implications for early detection of field loss and appropriate therapeutic intervention to maintain function and quality of life.