New research presented at the American Academy of Ophthalmology’s (AAO) annual meeting in Chicago reveals that long-term, low-dose antiviral treatment significantly lowers the risk of recurring eye disease linked to shingles. This breakthrough study offers renewed hope for patients suffering from herpes zoster ophthalmicus (HZO), a condition caused by shingles that can result in vision loss and chronic pain.
Shingles, caused by the reactivation of the varicella-zoster virus, which lies dormant in nerve cells after childhood chickenpox, commonly manifests as painful rashes. However, when the virus affects the nerves of the forehead and eyes, it leads to HZO. This condition can trigger keratitis (inflammation of the cornea) and iritis (inflammation inside the eye), both of which can cause severe pain, vision impairment, and, in extreme cases, glaucoma.
The findings come from the eight-year Zoster Eye Disease Study (ZEDS), which showed that patients treated with the antiviral drug valacyclovir (Valtrex) had a 26% lower risk of developing or worsening eye disease over an 18-month period compared to those given a placebo. Additionally, the study found a 30% reduction in flare-ups at 12 months and a 28% reduction at 18 months in patients receiving antiviral therapy.
Aside from reducing eye inflammation, the treatment also shortened the duration of pain and reduced reliance on medications like pregabalin and gabapentin, commonly prescribed for post-herpetic neuralgia (PHN). These medications, though effective, often cause side effects such as dizziness, which can be especially dangerous for older adults.
“Our findings underscore the importance of preventive antiviral treatment, not only for reducing eye disease but also for alleviating the chronic pain often associated with shingles,” said Dr. Elisabeth J. Cohen, the study’s principal investigator and professor of ophthalmology at NYU Grossman School of Medicine. Dr. Cohen’s personal battle with HZO, which forced her to end her career as a corneal surgeon in 2008, served as a major motivation behind her research.
The ZEDS study, funded by the National Eye Institute (NEI), was conducted across 95 medical centers in the U.S., Canada, and New Zealand, involving 527 participants. Each patient was given either 1,000 mg of valacyclovir or a placebo daily, using a double-masked trial method to ensure unbiased outcomes. All participants had active or recent keratitis or iritis, functional immune systems, and a history of shingles rash.
“This study provides strong evidence in favor of long-term, low-dose antiviral therapy as an effective strategy for minimizing HZO complications and improving patient outcomes,” said Dr. Bennie Hau Jeng, co-chair of the study and chair of the Department of Ophthalmology at the University of Pennsylvania.
Beyond treatment, Dr. Cohen emphasized the importance of vaccination. “While these findings mark a significant advancement in managing HZO, prevention remains crucial. The Shingrix vaccine, which has been recommended for adults 50 and older since 2018, is highly effective, yet only 12% of those eligible have received it.” Dr. Cohen also noted that the vaccine guidelines were recently expanded to include immunocompromised adults aged 19 and older.
With backing from the National Shingles Foundation and additional research grants, the ZEDS study paves the way for a new standard in clinical practice, advocating for the use of suppressive antiviral therapy to not only reduce eye disease flare-ups but also limit the need for neuropathic pain medications.
As the incidence of shingles continues to rise, particularly among older adults and immunocompromised individuals, this study highlights the increasing need for effective strategies to manage shingles-related complications.
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