Introduction: Human Immunodeficiency Virus [HIV] is known to cause premature ageing leading to reduction in amplitude of accommodation It is associated with many other ocular and systemic diseases.

Aim: The primary objective was to find out if HIV-positive patients on Anti Retroviral Treatment [ART] have significantly reduced amplitude of accommodation compared with controls. The secondary objective was to investigate accommodative impairment in relation to factors such as age, CD4 count and current antiretroviral treatments.

Method: It was a cross sectional, open and prospective single center study in a tertiary care hospital in Western Maharashtra. It involved 200 HIV-positive patients on ART aged from 35 years to 45years with no previous history of eye problems and 200 age-matched controls.

Results: Blur reported by  HIV patients using  Royal Air Force [RAF] ruler for 35- 39 years age group was 27.94% [19/68] while for control group it was 2.08%[2/96], [p value <0.001]Reduced amplitude of accommodation below age expected norms was also observed. For age group 40-45 years , reduction in amplitude of accommodation  found for HIV patients and control was 92.42% and 95.09% respectively, [p Value <0.001]Accommodation failure was  not related to CD4 count  or current ART being used.

Conclusion: This study has identified accommodative failure in a   significant proportion of HIV-positive patients on ART aged between 35and 45years. This problem may be under-recognized. The need for near correction for the pre presbyopic age is often overlooked. Accommodation failure was not related to CD4 count or current ART being used.

Keywords: Amplitude of accommodation, RAF ruler, HIV, ART.