Telemedicine Screening for Cytomegalovirus Retinitis at the Point of Care for Human Immunodeficiency Virus Infection

Abstract

Cytomegalovirus (CMV) retinitis is a leading cause of blindness in many developing countries with a high burden of AIDS.^1-5 The condition causes full-thickness retinal necrosis and irreversible blindness if left untreated.^6,7 Therefore, detection of CMV retinitis before the patient loses vision is important. The standard of care is to perform screening for patients who have a CD4 cell count of less than 100/μL (to convert to ×10⁹/L, multiply by 0.001) with indirect ophthalmoscopy every 3 months. However, screening is not performed routinely in many developing countries owing to limited ophthalmic care.^8-11 Patients often have severe manifestations of disease by the time they seek care.^12,13 New strategies are needed to increase the number of patients who are diagnosed as having CMV retinitis before the disease causes vision loss. Because CD4 testing is the primary indication for screening, it would be most effective if screening were initiated by the clinician treating the patient for human immunodeficiency virus (HIV) infection.^2,13,14