Screening for cytomegalovirus retinitis in HIV-positive and AIDS patients.

The ability of physicians to screen for AIDS-related cytomegalovirus retinitis (CMVR) was studied at a London AIDS centre. Patients had undergone direct ophthalmoscopy as part of their general examination by the physicians and were referred if fundal abnormalities were found, if a focus of extra-ocular CMVR was present or if the patient complained of visual symptoms. The provisional diagnoses of the physicians were compared with the final diagnoses of the ophthalmologists. Of 348 consecutive patients referred for an ophthalmic opinion, the physicians made the correct diagnosis in 69% of those referred with a provisional diagnosis of CMVR, in 66% of those with normal fundi and in 81% of those with toxoplasma chorioretinitis. Those cases of CMVR which were misdiagnosed by the physicians were usually mistaken for other retinal pathology which would warrant a specialist referral. Screening for CMVR in HIV-positive and AIDS patients may safely be undertaken by physicians familiar with the ocular manifestations of HIV-related disease.