The Prevalence and Causes of Visual Loss Among HIV-Infected Individuals in Uganda

Aim: To determine the prevalence of loss of visual acuity and to describe the ocular diseases associated with vision loss among HIV-infected individuals in Uganda. Methods: One thousand two hundred twelve HIV-positive individuals aged 18 years or older attending an HIV treatment site in Kampala, Uganda, were consecutively screened for loss Of visual acuity using a Snellen chart. Those found to have a visual acuity of 6/9 or less in 1 or both eyes had a detailed Ocular diagnostic evaluation. Results: One hundred thirty-six patients [11.2%; 95% confidence interval (CI): 9.49-13.13] had a visual acuity of 6/9 or less in at least 1 eye, with 74 (6.1%; 95% CI: 8.54-12.21) having bilaterally reduced presenting visual acuity. Eighty-eight (7.3%; 95% CI: 8.57-12.28) had a visual acuity of 6/18 or worse in at least 1 eye. Ocular diseases associated with reduced vision included cataract 16 (11.8%), optic nerve disease 20 (14.7%), refractive errors 35 (24.3%), and uveitis 44 (32.3%). Other diagnoses observed included diabetic retinopathy, maculopathies, corneal scars, glaucoma, and squamous cell carcinoma of the conjunctiva. Conclusions: Visual impairment and ocular disease affect a large proportion of HIV-infected individuals presenting for HIV care in Uganda. Most causes of vision loss were treatable or could have been prevented with appropriate ophthalmic and medical care.