Mohammed Nawaiseh1, Allaa Roto2, Yara Nawaiseh3, Mohammad Salameh4, Rund Haddadin5, Lana Mango5, Hussam Nawaiseh5, Doha Alsaraireh5, Qais Nawaiseh5, Saif Aldeen AlRyalat6, Amer Alwreikat7,8, David J Ramsey7,8, Nakhleh Abu-Yaghi9. 1. King Hussein Cancer Center, Amman, Jordan. 2. Al Bahar Eye center, Ibn Sina Hospital, Ministry of Health, Kuwait city, Kuwait. 3. Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. 4. Hamad Medical Corporation, Doha, Qatar. 5. School of Medicine, The University of Jordan, Amman, Jordan. 6. Department of Special Surgery, Ophthalmology Division, School of Medicine, The University of Jordan, P.O. Box: 7599, Amman, 11118, Jordan. 7. Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA. 8. Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA. 9. Department of Special Surgery, Ophthalmology Division, School of Medicine, The University of Jordan, P.O. Box: 7599, Amman, 11118, Jordan. n.abuyaghi@ju.edu.jo.
Abstract
BACKGROUND: Sickle cell retinopathy (SCR) is one of the most important ocular manifestations of sickle cell disease (SCD). This study aims to assess the prevalence of SCR in SCD, identify risk factors for its development and progression to proliferative sickle cell retinopathy (PSCR), and evaluate the potential implications of these results on clinical practice. METHODS: This research is a secondary analysis of patients diagnosed with SCD from the epidemiological, multicenter Cooperative Study of Sickle Cell Disease (CSSCD). We included all patients who completed a full ophthalmic evaluation. We identified clinical and laboratory SCD characteristics associated with SCR using multivariate logistic regression models. Proliferative sickle cell retinopathy (PSCR) was diagnosed according to the Goldberg classification system. RESULTS: Of the 1904 study participants with SCD who met the inclusion criteria, 953 (50.1%) had retinopathy; of which 642 (67.3%) had bilateral disease. SCR was associated with older age (p < 0.001), history of smoking (p = 0.001), hematuria (p = 0.050), and a lower hemoglobin F (HbF) level (p < 0.001). PSCR risk increased with smoking (p = 0.005), older age (p < 0.001) higher hemoglobin level (p < 0.001) and higher white blood cell count (p = 0.011). Previous blood transfusion (p = 0.050), higher reticulocyte count (p = 0.019) and higher HbF level (p < 0.001) were protective factors against the development of PSCR. Ocular symptoms were associated with progression to PSCR in patients with SCR (p = 0.021). CONCLUSION: In this cohort of individuals with SCD, half of the participants had signs of SCR. Smoking and blood hemoglobin level were the two modifiable risk factors associated with increased retinopathy progression. Screening to identify the different stages of retinopathy, actively promoting smoking cessation, and optimizing the hematological profile of patients with SCD should guide treatment protocols designed to prevent the vision-threatening complications of the disease.
BACKGROUND: Sickle cell retinopathy (SCR) is one of the most important ocular manifestations of sickle cell disease (SCD). This study aims to assess the prevalence of SCR in SCD, identify risk factors for its development and progression to proliferative sickle cell retinopathy (PSCR), and evaluate the potential implications of these results on clinical practice. METHODS: This research is a secondary analysis of patients diagnosed with SCD from the epidemiological, multicenter Cooperative Study of Sickle Cell Disease (CSSCD). We included all patients who completed a full ophthalmic evaluation. We identified clinical and laboratory SCD characteristics associated with SCR using multivariate logistic regression models. Proliferative sickle cell retinopathy (PSCR) was diagnosed according to the Goldberg classification system. RESULTS: Of the 1904 study participants with SCD who met the inclusion criteria, 953 (50.1%) had retinopathy; of which 642 (67.3%) had bilateral disease. SCR was associated with older age (p < 0.001), history of smoking (p = 0.001), hematuria (p = 0.050), and a lower hemoglobin F (HbF) level (p < 0.001). PSCR risk increased with smoking (p = 0.005), older age (p < 0.001) higher hemoglobin level (p < 0.001) and higher white blood cell count (p = 0.011). Previous blood transfusion (p = 0.050), higher reticulocyte count (p = 0.019) and higher HbF level (p < 0.001) were protective factors against the development of PSCR. Ocular symptoms were associated with progression to PSCR in patients with SCR (p = 0.021). CONCLUSION: In this cohort of individuals with SCD, half of the participants had signs of SCR. Smoking and blood hemoglobin level were the two modifiable risk factors associated with increased retinopathy progression. Screening to identify the different stages of retinopathy, actively promoting smoking cessation, and optimizing the hematological profile of patients with SCD should guide treatment protocols designed to prevent the vision-threatening complications of the disease.
Authors: Jonathan Li; Lloyd Bender; James Shaffer; Daniel Cohen; Gui-Shuang Ying; Gil Binenbaum Journal: Ophthalmology Date: 2019-03-02 Impact factor: 12.079
Authors: Susan M Downes; Ian R Hambleton; Elaine L Chuang; Noemi Lois; Graham R Serjeant; Alan C Bird Journal: Ophthalmology Date: 2005-09-19 Impact factor: 12.079