R Wilson1. 1. New England College of Optometry, Beacon St., Boston, MA 02115.
Abstract
BACKGROUND: Cotton wool spots (CWS) result from infarctions of the retinal nerve fiber layer and are seen in a variety of clinical conditions. Most patients with human immunodeficiency virus (HIV) disease, the agent that causes the acquired immune deficiency syndrome (AIDS), demonstrate CWS at some point during their illness. CWS are the most prevalent ocular manifestation found in persons with AIDS. METHODS: A review of the literature was conducted and interpreted to merge a variety of scientific data and clinical studies into a discussion of the etiology, pathophysiology, clinical significance and patient management approaches in patients with AIDS who have CWS. RESULTS: Numerous studies demonstrate a relationship between CWS in patients with low CD4+ lymphocyte cell counts (< 50-100/mm3 of blood), the risk for HIV disease progression, and the development of opportunistic diseases. CONCLUSIONS: While the overall clinical significance of CWS in AIDS is still evolving, it appears that CWS in healthy HIV positive patients have relatively little clinical significance. However, present data suggests that CWS in patients with very low CD4+ counts and advanced HIV disease is a negative prognostic sign. Therefore, CWS in profoundly immunosuppressed patients with low CD4+ counts should alert the optometrist to follow the patient closely.
BACKGROUND: Cotton wool spots (CWS) result from infarctions of the retinal nerve fiber layer and are seen in a variety of clinical conditions. Most patients with human immunodeficiency virus (HIV) disease, the agent that causes the acquired immune deficiency syndrome (AIDS), demonstrate CWS at some point during their illness. CWS are the most prevalent ocular manifestation found in persons with AIDS. METHODS: A review of the literature was conducted and interpreted to merge a variety of scientific data and clinical studies into a discussion of the etiology, pathophysiology, clinical significance and patient management approaches in patients with AIDS who have CWS. RESULTS: Numerous studies demonstrate a relationship between CWS in patients with low CD4+ lymphocyte cell counts (< 50-100/mm3 of blood), the risk for HIV disease progression, and the development of opportunistic diseases. CONCLUSIONS: While the overall clinical significance of CWS in AIDS is still evolving, it appears that CWS in healthy HIV positive patients have relatively little clinical significance. However, present data suggests that CWS in patients with very low CD4+ counts and advanced HIV disease is a negative prognostic sign. Therefore, CWS in profoundly immunosuppressed patients with low CD4+ counts should alert the optometrist to follow the patient closely.