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People living with HIV (PLWH) may face an increased risk of eye complications associated with ageing, chronic inflammation, and the toxicity arising from long-term antiretroviral therapy (ART). This review aims to understand how inflammatory pathways contribute to retinal alterations observed in PLWH on long-term ART. This review was conducted using four electronic database searches, namely Scopus, Hinari, Google Scholar, and PubMed; from 1996 (when ART became available) until January 2022, without language restriction. Sources from clinical trials, meta-analyses, randomised controlled trials, and systematic reviews were used. Dysregulated para-inflammation (chronic inflammation) damages the blood-retina barrier, resulting in the altered retinal immune privilege and leading to the development of retinal and blood vessel changes. There is an interplay between the effects of the disease versus ART. ART causes mitochondrial toxicity, which affects the retinal ganglion cells and retinal pigment epithelium (RPE) due to oxidative stress. Infection by HIV also affects retinal microglia, which contributes to RPE damage. Both of these mechanisms affect the blood vessels. Assessing the integrity of the inner and outer blood-retina barrier is a pivotal point in pinpointing the pathogenesis of inner retinal alterations. Optical coherence tomography is a valuable tool to assess these changes. There is a paucity of research to understand how these structural changes may affect visual function, such as contrast sensitivity and colour vision. [ABSTRACT FROM AUTHOR]

Background: This study sought to establish the association between retinal morphology, visual function and linear parameters of cerebral atrophy in non‐immunocompromised people living with HIV (NIPLHIV). Methods: Sixty participants (30 NIPLHIV, 30 controls), aged 18–45 years, were sourced from an outpatient clinic in South Africa. NIPLHIV on antiretroviral therapy (ART) had elevated CD4 counts and low viral loads. Macula thickness and volume measurements were obtained using the Spectralis optical coherence tomographer. Contrast sensitivity (CS), colour vision and visual‐evoked potentials (VEP) were also obtained. Linear parameters of cerebral atrophy (Sylvian fissure ratio, SFR) and bicaudate nucleus ratio (BCR) were all acquired from computed tomography (CT) scans. Associations between retinal thickness and volume and visual function were established by principal component factor analysis. Results: CS scores were indirectly associated with the Inner Nuclear Layer (INL)‐ETDRS thickness and volume subfields (co‐efficient = −0.07; p = 0.02 and −0.11; p = 0.001), respectively. F100 total error scores (TES) were directly associated with the thicknesses of Ganglion Cell Layer‐ETDRS subfields (co‐efficient = 6.06; p = 0.04) but indirectly associated with INL‐ETDRS subfields (co‐efficient = −5.49; p = 0.04). F100‐TES were indirectly associated with volumes of RNFL (Retinal Nerve Fibre Layer)‐ETDRS subfields (co‐efficient = −5.54; p = 0.02) and inner retina ‐ETDRS subfields (co‐efficient = −6.70; p = 0.02). P100 latency was directly associated with RNFL‐ETDRS subfield thickness (co‐efficient = 2.90; p = 0.02) and volumes of outer retina subfields (co‐efficient = 2.72; p = 0.04). CS scores were directly associated with SFR (co‐efficient = −0.04; p = 0.01). F100‐TES were directly associated with BCR (co‐efficient = 0.003; p = 0.004) and SFR (co‐efficient = 0.002; p = 0.02). P100 latency was indirectly associated with BCR (co‐efficient = −0.001; p = 0.03). Conclusion: The recognition of associations may be the first step in the proposal to develop a framework for the surveillance of vision in patients with NIPLHIV. We recommend a study of the sample population to track the stability of these observations before general recommendations for clinical care. [ABSTRACT FROM AUTHOR]

Increased screen time (ST) in children is quickly becoming a public health concern as children are now reliant on technology for social interaction and educational development. The eye-health community has paid considerable attention to this in the recent literature, documenting it as digital eye strain. Continual close eye work and a lack of outdoor play contribute to digital eye strain and today's myopia epidemic. This is a cause for concern for public health stakeholders insofar as it leads to sedentary, screen-based behaviour (SSB) in children. This results in a lack of physical activity and impacts both their bodies and their mental health. The potentially harmful effects of prolonged screen exposure on developing brains and bodies are likely to be unique and significant as physiological growth changes intersect with exponentially expanding e-platforms. While embracing the benefits of a highly digitalised world, we need to simultaneously mitigate the potential risks they pose to the health of growing children. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLHIV) on antiretroviral therapy (ART) without retinitis may not have a healthy retinal structure. Aim: To examine the impact of the virus together with the ART medication in PLHIV without retinitis. Methods: This review used the following databases: PubMed, Google Scholar and EBSCOhost. Search terms included: HIV and/or retinal nerve fibre layer (RNFL); perimetry; colour vision; contrast sensitivity (CS); visual evoked potentials (VEPs); electroretinograms (ERGs); and the brain. All peer-reviewed studies related to PLHIV on ART without retinitis, up until September 2019, were included. Results: The mean RNFL thickness, and superior and inferior zones showed thinning. Affected visual functions include transient pattern VEP and ERG; contrast sensitivity; reduced total error scores on colour vision evaluation; and reduced mean deviation and pattern standard deviations on perimetry. Studies also showed concurrent thinning of the peripapillary retinal nerve fibre layer (ppRNFL) and perimetry, contrast sensitivity and colour vision. All these significant observations were seen at a cluster of differentiation 4 (CD4) count of less than 200 cells/mm3 in PLHIV on ART with no retinitis. Further to this, studies have also related the retina to grey and white matter changes in PLHIV in the era of ART. A gap in research involves studies on the vascular impact of ART on the retina, which should be factored into studies going forward when studying PLHIV on ART. Conclusion: The decrease in visual function, the RNFL changes and neuro-ophthalmic involvement in PLHIV allow us to recognise the threat to vision loss when factoring in the expected longer lifespan that PLHIV on ART are afforded today. [ABSTRACT FROM AUTHOR]

Background: One of the leading causes of preventable blindness is cataract affecting approximately 18 million people worldwide. Twenty per cent of cataract operations worldwide are performed on people with diabetes mellitus (PDM). Aim: The aim of this review article is to analyse the scientific literature relating to visual changes associated with diabetes mellitus (DM) in pseudophakic, aphakic and phakic people, and to discuss the consequences of these changes for optometrists. Method: A literature search was conducted on PubMed, the University of KwaZulu-Natal Libraries and Google Scholar databases from August 2017 to August 2018. Results: Acute and chronic hyperglycaemia in DM causes myopia in phakic PDM, whilst in aphakic PDM it causes a hyperopic shift in refraction. It has been reported that contrast sensitivity and visual acuity are affected by changes in blood glucose. People with DM have increased central corneal thickness as compared to non-diabetics, whilst only the posterior corneal curvature is affected by hyperglycaemia in PDM. No evidence exists on the effects of glycaemic changes in pseudophakes. Conclusion: It should be noted that high blood glucose level (BGL) induces transient myopia and hyperopia in chronic phakic PDM and aphakic PDM, respectively. All refractive procedures, including prescription of spectacles, corneal refractive procedures and lens extraction, should be deferred until normalisation of BGL in phakic and pseudophakic PDM, as higher sugar levels affect corneal curvature and thickness and overall vision. [ABSTRACT FROM AUTHOR]