CMV Retinitis Diagnosis by Non-ophthalmologists: Learning Curve Over a 4-Day Training Workshop.

To the Editors: Cytomegalovirus (CMV) retinitis is a blinding opportunistic infection that primarily affects people with AIDS in resource-limited settings. Screening for CMV retinitis is important because the infection can cause irreversible retinal destruction before the onset of visual symptoms. Routine screening is recommended for patients with CD4 counts less than 100 cells per microliter and consists of a dilated fundus examination with an indirect ophthalmoscope. However, screening rarely occurs in lowand middle-income countries because ophthalmologists are usually not available. As a result, clinical outcomes are poor, with roughly one-third of eyes already blind by the time they are diagnosed with CMV retinitis. Given the lack of CMV retinitis screening for its HIV population, the Médecins Sans Frontières Yangon Project initiated a program in 2006 to train its AIDS physicians how to diagnose and treat CMV retinitis at the point-of-care. An outside ophthalmologist (D.H.) designed and implemented a 4-day training program to transfer the skills of binocular indirect ophthalmoscopy for CMV retinitis diagnosis. The workshop has been repeated every year since. In this study, we retrospectively reviewed the records from 2 of the workshops to determine the sensitivity and specificity of CMV retinitis diagnosis by non-ophthalmologists over the course of a 4-day training workshop.