Herpes zoster ophthalmicus (HZO) can be a serious matter, with the condition affecting vision longer term in 10% of cases, according to a recent report.

In an article in the American Journal of Ophthalmology, New Zealand researchers report that the most common sites of ocular involvement were conjunctivitis (76.1%), followed by keratitis (51.2%) and uveitis (47.6%). Moderate vision loss occurred in 9.6% of the study group with HZO, while severe vision loss occurred in 3.6%.

Causes of loss of vision included corneal scarring (94.0%), corneal perforation (4.8%), and secondary glaucoma (1.2%), according to the authors, who add that severe vision loss appeared to be most associated with older age, poor presenting visual acuity, and uveitis.

That’s why another study team, from the University of California San Francisco, considered it so essential to examine the effectiveness of the recombinant zoster vaccine (RZV) for preventing herpes zoster ophthalmicus in the general U.S. population.

The focus was on 4.8 million adults enrolled in the OptumLabs Data Warehouse (OptumLabs, Cambridge, Massachusetts) who were age 50 years or older and eligible for herpes zoster vaccination from 2018 through 2019. The database includes de-identified administrative claims and electronic health record database of patients in the U.S. with commercial insurance, Medicare Part D, or Medicare Advantage

Researchers sought to determine the Incidence of herpes zoster ophthalmicus in vaccinated versus unvaccinated person-time, with the goal of also assessing vaccine effectiveness.

Of the participants, 3.7% received two valid doses of RZV. The authors determined that the incidence rate of herpes zoster ophthalmicus was 25.5 (95% CI,17.4, 35.8) cases per 100,000 person-years in the vaccinated group compared with 76.7 (95% CI, 74.7, 78.7) in the unvaccinated group. That meant the overall adjusted effectiveness of RZV against herpes zoster ophthalmicus was 89.1% (95% CI, 82.9, 93.0), they write.

“The effectiveness of RZV against herpes zoster ophthalmicus in individuals ages 50 years old and above is high in a real-world setting,” according to the researchers. “However, the low vaccination rate in this study highlights the public health need to increase herpes zoster vaccination. Ophthalmologists can play an important role in recommending vaccination to eligible patients.”

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