Even though vaccines against shingles are highly effective, the rate of eye complications of herpes zoster is skyrocketing, a new study has found.
Among a group of 21 million adults, occurrences of herpes zoster ophthalmicus (HZO) tripled over a 12-year period, according to Kellogg Eye Center research presented at the 2019 Association for Research in Vision and Ophthalmology annual meeting in Vancouver.
Study author Nakul Shekhawat, MD, MPH, said prevention of HZO is crucial “because of the severity of the disease and potential sight-threatening complications.”
Incidence of herpes zoster ophthalmicus across the United States rose substantially between 2004 and 2016, occurring in 9.4 cases per 100,000 people at the beginning of the study period and growing threefold to 30.1 cases per 100,000 by the end of the study period, according to the research.
Symptoms and signs, which may be severe, include dermatomal forehead rash and painful inflammation of all tissues of the anterior and, on occasion, posterior structures of the eye. Complicating matters is that keratitis and/or uveitis might be severe and cause scarring. Vision can be affected by late sequelae, such as glaucoma, cataract, chronic or recurrent uveitis, corneal scarring, corneal neovascularization, and hypesthesia.
Furthermore, patients can develop retinitis with risk of severe vision loss.
The two groups with the highest rates of infection were women and adults older than age 75 years, who had as many as 53 cases per 100,000. The results were based on health claims data for patients enrolled in a large nationwide managed care plan.
“Older patients were at far greater risk for HZO, highlighting just how important it is for older adults to get the shingles vaccination,” explained Dr. Shekhawat, a comprehensive ophthalmologist at the University of Michigan Department of Ophthalmology and Visual Sciences.
In terms of race, whites were more likely than other racial groups to be diagnosed with HZO, with a rate of 30.6 cases per 100,000. The rate among blacks was 23.4 per 100,000, followed by Asians (21.0) and Latinos (14.6), according to the presentation.
Background information in the study pointed out that shingles vaccination provides strong protection against shingles and its complications, but the vaccine is not widely used. It notes that two doses of recombinant zoster vaccine, marketed as Shingrix, are more than 90% effective at preventing shingles and are recommended for those aged 50 years and older.
The CDC advises that even if an adult has had shingles in the past, the vaccine can help prevent future occurrences.
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