Studies Shine Light on Herpes Zoster Ophthalmicus

Two recent studies from the University of Michigan examining different aspects of herpes zoster ophthalmicus (HZO), or shingles of the eyes, underscore the importance of shingles vaccinations for high-risk populations and the disease’s two greatest potential eye complications, corneal scarring and blindness.  

The first study from the Kellogg Eye Center was presented at the 2019 Association for Research in Vision and Ophthalmology annual meeting in Vancouver. Researchers analyzed health claims data for 21 million adults and was supported by Eversight Eye Bank and the Blue Cross Blue Shield of Michigan Foundation. 

Researchers found that the incidence of HZO tripled over a 12-year period in the United States. Specifically, the number of HZO cases rose steadily and substantially, from 9.4 cases per 100,000 people in 2004 to 30.1 cases per 100,000 in 2016. 

The rate for women (29.1) was higher than among men. The highest HZO rate of 53 cases per 100,000 was reported among adults over the age of 75. Among ethnic groups, whites were diagnosed at a much higher rate (30.6) than blacks (23.4), Asians (21.0) and Latinos (14.6). 

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According to a prepared statement from the university, researchers believed it was important to identify the patients at greatest risk for HZO and how to prevent it due to the severity of the disease and its potential sight-threatening complications. 

The second study, published in the British Journal of Ophthalmology, found that corneal transplants are effective for shingles-related complications. 

Researchers reviewed the medical records of 53 corneal transplant patients who suffered corneal scarring, the most common complication of HZO. All of them had undergone penetrating keratoplasty (PKP) at Kellogg, in most cases six years after they had shingles.

The study reported a 94% graft survival rate a year after surgery, 82% at two to four years, and 70% at five or more years of follow-up. Although most of the grafts remained clear, researchers noted that long-term visual potential may be limited by comorbid ocular diseases, including cataract, glaucoma, and macular disease.

The researchers concluded that even in eyes with significant preoperative risk factors, PKP for the corneal complications of HZO can achieve favorable structural and visual results. 

Vaccinations are the only protection currently available against shingles. The CDC’s Advisory Committee on Immunization Practices has given preference to Shingrix over Zostavax for healthy people aged 50 because of its higher efficacy rate.

Researchers in the first study cited highlighted that two doses of Shingrix are more than 90% effective at preventing shingles and can also help prevent future occurrences of shingles.