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Factors Associated With Age of Onset of Herpes Zoster Ophthalmicus

Chan, Annie Y. MD; Conrady, Christopher D. MD, PhD; Ding, Kai PhD; Dvorak, Justin D. BS; Stone, Donald U. MD

doi: 10.1097/ICO.0000000000000362
Clinical Science

Purpose: The aim of this study was to evaluate factors associated with the age of onset of herpes zoster ophthalmicus (HZO) in the era of varicella vaccination.

Methods: A retrospective series of 400 subjects with a diagnosis of HZO, and an analysis of public health databases. Variables studied included the age at onset, period of disease onset (1996–2004 and 2005–2012), sex, smoking habits, diabetes status, autoimmunity, and immunosuppressed status. Community data were gathered from the Oklahoma Outpatient Surgery Discharge Public Use Data File and the United States Census' American Community Survey data set.

Results: The mean onset age was significantly lower for 2005 to 2012 as compared with 1996 to 2004 among females (mean decrease, 9.3 years; 95% confidence interval, 4.6–13.9 years; P < 0.0001), but the mean onset age was similar between the 2 periods among males (P = 0.640). Whereas 32.3% of the patients with zoster were <60 years old in 1996 to 2004, compared with 44.8% in the 2005 to 2012 period (χ2 test: P = 0.017). In the multivariate model, smokers were found to have disease onset 11.5 (95% confidence interval, 6.9–16.1) years younger than nonsmokers.

Conclusions: The proportion of younger patients with HZO increased, whereas the institutional and community data sets demonstrate a downward shift of the average age of onset of HZO among females. This may be an effect of widespread childhood varicella vaccination. Immunosuppression and smoking were also associated with a younger age of onset of HZO. This has implications for clinical care of patients at risk for developing HZO, as well as public health and vaccination policies.

*Department of Ophthalmology, University of Oklahoma Dean McGee Eye Institute, Oklahoma City, OK;

Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK;

Department of Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins University, Baltimore, MD; and

§King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Reprints: Donald U. Stone, MD, Research Department, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia, 11462 (e-mail:

Supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Oklahoma Department of Ophthalmology and the Dean McGee Eye Institute. D. U. Stone has served as a consultant for Santen Inc.

The authors have no other conflicts of interest to disclose.

A. Y. Chan and C. D. Conrady have contributed equally to this study.

All authors had full access to all of the data presented herein and take full responsibility for the integrity of the data and the accuracy of data analysis.

Received October 04, 2014

Received in revised form November 20, 2014

Accepted November 30, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.