Association Between Abnormal Contrast Sensitivity and Mortality Among People With Acquired Immunodeficiency Syndrome

Holland, Gary N.; Kappel, Peter J.; Van Natta, Mark L.; Palella, Frank J.; Lyon, Alice T.; Shah, Kayur H.; Pavan, Peter R.; Jabs, Douglas A.; Studies of the Ocular Complications of AIDS Research Group,

doi:10.1016/j.ajo.2009.12.019

« Previous Next »American Journal of Ophthalmology
Volume 149, Issue 5 , Pages 807-816, May 2010

Association Between Abnormal Contrast Sensitivity and Mortality Among People With Acquired Immunodeficiency Syndrome

Gary N. Holland
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Inquiries to Gary N. Holland, Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 90095-7003
Peter J. Kappel
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
Mark L. Van Natta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Frank J. Palella
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Alice T. Lyon
- Retina Study Center, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Kayur H. Shah
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
Peter R. Pavan
- Department of Ophthalmology, University of South Florida College of Medicine, Tampa, Florida
Douglas A. Jabs
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
Studies of the Ocular Complications of AIDS Research Group

Accepted 15 December 2009.

Purpose

To investigate the relationship between contrast sensitivity (CS) and mortality among people with acquired immunodeficiency syndrome (AIDS); and to explore the hypothesis that abnormal CS is a marker of systemic, life-threatening microvascular disease.

Design

Longitudinal, observational cohort study.

Methods

We evaluated 3395 eyes of 1706 individuals enrolled in the Longitudinal Study of the Complications of AIDS (1998–2008). CS was evaluated as a risk factor for death, and was compared to the presence of systemic diseases characterized by microvasculopathy (diabetes, cardiovascular disease, stroke, renal disease) and to laboratory markers of those diseases. Abnormal CS was defined as logCS <1.5 (lower 2.5th percentile for a normal control population).

Results

CS was abnormal in 284 of 1691 (16.8%) study participants at enrollment. There was a positive relationship between the presence of abnormal CS at study entry and mortality (relative risk 2.0, 95% confidence interval 1.7-2.3, P < .0001). Abnormal CS was related to the presence of cardiovascular disease, stroke, and renal disease (all P values ≤ .01), but abnormal CS remained associated with death even after adjustment for these diseases and for other known predictors of death among people with AIDS. Diseases characterized by microvasculopathy were more often identified as causes of death among individuals with abnormal CS than among those with normal CS, although the strength of the association was moderate (P = .06).

Conclusions

Abnormal CS among people with AIDS is associated with increased mortality, and is independent of other risk factors for death that are monitored routinely. The relationship may indicate life-threatening microvascular disease in other organs.