Accommodative-Convergence Mechanism failure in HIV-Positive Non-Presbyopic Patient on Highly Active Anti-Retroviral Therapy: A case report.

Sadiq Hassan¹, Philips I. Ebisike², Christopher O. Timothy³, Basheer A. Z Chedi⁴, Rabi Y. Sani¹, Saudat G. Habib¹

Department of Ophthalmology, Faculty of Clinical Sciences, College of Health Sciences, Bayero
University Kano/ Aminu Kano Teaching Hospital Kano, Nigeria.
Department of Optometry, Faculty of Allied Health Sciences, College of Health Sciences, Bayero
University Kano/ Department of Ophthalmology, Aminu Kano Teaching Hospital Kano, Nigeria.
Department of Optometry, Faculty of Health Science, College of Medicine and Health Sciences, Abia
State University Uturu, Nigeria.
Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University
Kano, Nigeria.

Corresponding Author: Ebisike Philips Ifeanyichukwu Email: philipsokere@yahoo.com | + 234 (0)7035360969.

Abstract

Purpose: Accommodative-convergence mechanism failure could occur in non-presbyopic HIV- seropositive patients on Highly Active Anti-Retroviral Therapy (HAART). This could be due to either direct neuronal infection by HIV, pathologic changes of the lens or the ciliary body or adverse effects of some individual drugs constituting the HAART regimen on the cranial nerves which play vital roles in the mechanism of accommodation and convergence.

Case report: This is a case report of an accommodative- convergence mechanism failure in HIV positive non-presbyopic 32-year-old male patient that was on HAART for more than five years. He presented with distance visual acuity (VA) of OD: 6/9+2, OS: 6/9, and near visual acuity (NVA) of N24 both eyes,3∆esophoria at distance and 4∆ esophoria at near. The amplitude of accommodation (AA) was 3.50D and accommodative convergence/accommodation (AC/A) ratio was 6/1. Following a comprehensive evaluation, his refractive correction was OD: Plano/-0.50DC X 180 6/5 and OS: Plano/-0.50DC X 90 6/5 at distance with a near addition
(Add) 2.50D N5. This was prescribed for regular wear in the form of D-Top bifocal lens.

Conclusion: These findings showed that HIV seropositive adults on HAART could develop accommodative convergence mechanism failure, which may be characterized by the low amplitude of accommodation, receded near point of convergence and high non-presbyopic reading addition. These conditions may be under-recognized and need for reading addition of a non-presbyopic age is often overlooked.

Keywords: Accommodative-Convergence, HIV, Lateral Phoria, Refractive error