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Reilly GR, Xie Y, Scherer RW, Hawkins BS, Lanzkron SM, Scott AW. Terminology for Retinal Findings in Sickle Cell Disease Research: A Scoping Review. Ophthalmol Retina 2024; 8:81-87. [PMID: 37634744 PMCID: PMC10841206 DOI: 10.1016/j.oret.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/14/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To review the current sickle cell disease (SCD) literature to assess how "retinopathy" has been defined and to identify ocular outcomes that have been measured and described. DESIGN A systematic scoping review of SCD literature was completed regarding ocular manifestations of SCD and vision outcomes across all medical specialties. SUBJECTS Participants with SCD and control patients were included in our data extraction. METHODS We reviewed English-language literature from 2000 to 2021 for eligible studies by searching PubMed, Google Scholar, Embase, and the Cochrane library using terms to encompass SCD and ocular findings. MAIN OUTCOME MEASURES Data collection included study information, patient characteristics, vision-related findings (inclusion criteria and/or study outcomes), and retinopathy characteristics (definition, when, how and by whom diagnosed). RESULTS We identified 4006 unique citations and 111 were included in the analysis. Ophthalmologists were senior authors of about half (59/111; 53.2%) of the articles; most articles were published between 2016 and 2021 (71/111; 70.0%). The studies had been conducted primarily in North America (54/111; 48.6%) or Europe (23/111; 20.7%); designs were cross-sectional (51/111; 45.9%), prospective cohort (28/111; 25.2%), retrospective cohort (27/111; 24.3%), and case-control (4/111; 3.6%). Among studies reporting any retinopathy, it was commonly defined as a combination of nonproliferative sickle cell retinopathy and proliferative sickle cell retinopathy (PSR; 52/87; 59.8%), infrequently as PSR only (6/87; 6.9%), or not defined at all (23/87; 26.4%). The Goldberg classification was used to grade retinopathy in almost half of the studies (41/87; 47.1%). Investigators reporting diagnostic methods used clinical fundus examination (56/111; 50.4%), OCT (24/111; 21.6%), fluorescein angiography (20/111; 18.0%), ultrawidefield fundus photographs (15/111; 13.5%), and OCT angiography (10/111; 9.0%), or did not report methods (28/111; 25.2%). CONCLUSIONS There are inconsistencies in documentation of methods and outcomes in studies of SCD ophthalmic findings. Particularly concerning is the lack of documentation of ophthalmic examination methods, qualifications of examiners, and clarity and specificity of sickle cell retinopathy definitions. With the increase in SCD treatment research and novel systemic therapies available, it is important to adopt clear and consistent descriptions and rigorous data collection and reporting of ophthalmic outcomes in SCD studies. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Grace R Reilly
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yangyiran Xie
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Roberta W Scherer
- Retired, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara S Hawkins
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie M Lanzkron
- Johns Hopkins University School of Medicine, Division of Hematology, Department of Medicine, Baltimore, Maryland
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Lynch G, Scott AW, Linz MO, Han I, Andrade Romo JS, Linderman RE, Carroll J, Rosen RB, Chui TY. Foveal avascular zone morphology and parafoveal capillary perfusion in sickle cell retinopathy. Br J Ophthalmol 2019; 104:473-479. [PMID: 31337609 PMCID: PMC6980907 DOI: 10.1136/bjophthalmol-2019-314567] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 11/30/2022]
Abstract
Background/aims To assess foveal avascular zone (FAZ) morphology and parafoveal capillary perfusion in patients with various stages of sickle cell retinopathy (SCR) using optical coherence tomography angiography (OCT-A). Methods This is a multi-institutional retrospective study of patients with various stages of SCR compared with healthy controls. Parafoveal OCT-A images obtained using a commercial spectral domain-OCT system were reviewed. Foveal-centred 3×3 mm full vascular slab OCT-As were used for image processing and data analysis. FAZ area, perimeter, and acircularity index were determined on the OCT-A image after manual delineation of the FAZ border. Quadrant-based parafoveal capillary density and per cent area deviating from normal distribution were also measured. Results Fifty-two patients with SCR (33 non-proliferative and 19 proliferative) and 20 age and race-matched healthy controls were included. One randomly selected eye per study participant was analysed. FAZ perimeter and acircularity index were significantly greater in SCR eyes when compared with the controls. While parafoveal capillary density was significantly lower, per cent area deviated from normal distribution was significantly higher in SCR eyes than that of the control. However, no statistically significant difference between the two SCR stages was observed. In quadrant-based analysis, the temporal quadrant showed greater parafoveal capillary dropout due to SCR, with the most profound effect in patients with proliferative SCR. Conclusions Abnormal FAZ morphology and altered parafoveal capillary perfusion were found in patients with SCR. Our customised OCT-A image analysis method uniquely highlights significant quantitative alterations in perfusion density mapping in a qualitative display, with minimal obscuration of OCT-A image detail.
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Affiliation(s)
- Giselle Lynch
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA
| | - Marguerite O Linz
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA
| | - Ian Han
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA.,Ophthalmology & Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Jorge S Andrade Romo
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA
| | - Rachel E Linderman
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Carroll
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Richard B Rosen
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Toco Y Chui
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA .,Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Kord Valeshabad A, Wanek J, Zelkha R, Lim JI, Camardo N, Gaynes B, Shahidi M. Conjunctival microvascular haemodynamics in sickle cell retinopathy. Acta Ophthalmol 2015; 93:e275-80. [PMID: 25429907 DOI: 10.1111/aos.12593] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 10/06/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine alterations in bulbar conjunctival microvascular haemodynamics in sickle cell retinopathy (SCR) subjects with focal macular thinning (FMT). METHODS Conjunctival microcirculation imaging and spectral domain optical coherence tomography (SD-OCT) were performed in 22 subjects (eyes) diagnosed with SCR. Based on evaluation of SD-OCT retinal thickness maps, eyes were assigned to one of the two groups: with or without FMT. Conjunctival venular diameter and axial blood velocity were measured in multiple venules in each eye by customized image analysis algorithms. Measurements were then categorized into two vessel size groups (vessel size 1 and 2) and compared between FMT groups. A Pearson correlation coefficient was computed to assess the relationship between retinal thickness and axial blood velocity. RESULTS Mean age, haematocrit, sickle cell haemoglobin type and median retinopathy score were not significantly different between the two groups (p ≥ 0.1). Retinal thickness in parafoveal and perifoveal temporal subfields was significantly lower in eyes with FMT as compared to eyes without FMT (p ≤ 0.04). There was a significant effect of FMT on axial blood velocity (p = 0.04), while the effect of vessel size was not significant (p = 0.4). In vessel size 1, axial blood velocity was lower in eyes with FMT than in eyes without FMT (p = 0.03), while in vessel size 2, there was no statistically significant difference between FMT groups (p = 0.1). In vessel size 1, there was a significant positive correlation between axial blood velocity and retinal thickness in the perifoveal (r = 0.48, p = 0.02) and parafoveal (r = 0.43, p = 0.04) temporal subfields. CONCLUSION Conjunctival axial blood velocity in small venules is reduced in SCR subjects with focal macular thinning.
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Affiliation(s)
- Ali Kord Valeshabad
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Justin Wanek
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Ruth Zelkha
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Jennifer I. Lim
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Nicole Camardo
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Bruce Gaynes
- Department of Ophthalmology; Loyola University Medical Center; Chicago Illinois USA
| | - Mahnaz Shahidi
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
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Lima CSP, Rocha EM, Silva NM, Sonatti MF, Costa FF, Saad STO. Risk factors for conjunctival and retinal vessel alterations in sickle cell disease. ACTA ACUST UNITED AC 2006; 84:234-41. [PMID: 16637843 DOI: 10.1111/j.1600-0420.2005.00604.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to clarify whether the clinical, laboratory and genetic aspects of sickle cell disease (SCD) influence the occurrence of vessel alterations in the conjunctiva and retina. METHODS A total of 102 SCD patients underwent biomicroscopical and retinal examination, in addition to evaluations of haemoglobin (Hb) and haematocrit (Ht) levels, fetal haemoglobin (HbF) estimations, serum creatinine and albuminuria levels, glomerular filtration rate (GFR) values, phenotypes, beta-globin gene haplotypes and alpha-thalassaemia. The relationship between ocular vessel alterations and clinical, laboratory and genetic features were evaluated using chi-squared or Fisher tests and logistic regression analysis. In 13 patients on enalapril treatment, a second ophthalmological evaluation was performed after a 12-month period to evaluate the longitudinal effect of the drug on ocular vessels. RESULTS Conjunctival vessel alteration (CVA) was not influenced by age, gender, HbF estimation, serum creatinine and albuminuria levels, GFR values, beta-globin gene haplotypes or alpha-thalassaemia. However, increased frequencies of CVA were found in patients with Hb </= 9.0 g/dl, Ht </= 26.7% and sickle cell anaemia (SS) phenotype. Retinal vessel alteration (RVA) was identified only in patients aged 17 years or older. Enalapril did not demonstrate ocular vessel amelioration after 12-months of daily use. CONCLUSION The results indicate that lower Hb and Ht levels and SS phenotype are risk factors for CVA, and age over 17 years may be risk factors for RVA in SCD patients.
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Affiliation(s)
- Carmen S P Lima
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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Leveziel N, Kirsch O, Lautier-Frau M, Driss F, Offret H, Labetoulle M. Maculopathie ischémique drépanocytaire résolutive après échange érythrocytaire. J Fr Ophtalmol 2005; 28:642-5. [PMID: 16141931 DOI: 10.1016/s0181-5512(05)81110-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors report a case of a young patient with a recent decrease in unilateral vision. He had homozygote sickle cell disease with multiple general complications. Fundus examination was normal apart from a mild alteration of the macular reflect in the left eye, but fluorescein angiography showed multiple arteriolar macular occlusions, explaining the decrease in vision in the left eye. After erythropheresis, vision acuity improved and fluorescein angiography showed reperfusion. This case suggests that transfusional exchange may improve acute macular ischemia secondary to sickle cell disease.
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Affiliation(s)
- N Leveziel
- Service d'Ophtalmologie, CHU du Kremlin-Bicêtre, Le Kremlin-Bicêtre, Paris
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Cheung ATW, Chen PCY, Larkin EC, Duong PL, Ramanujam S, Tablin F, Wun T. Microvascular abnormalities in sickle cell disease: a computer-assisted intravital microscopy study. Blood 2002; 99:3999-4005. [PMID: 12010800 DOI: 10.1182/blood.v99.11.3999] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The conjunctival microcirculation of 18 homozygous sickle cell disease (SCD) patients during steady-state, painful crisis, and postcrisis conditions was recorded on high-resolution videotapes using intravital microscopy. Selected videotape sequences were subsequently coded, frame-captured, studied, and blindly analyzed using computer-assisted image analysis protocols. At steady-state (baseline), all SCD patients exhibited some of the following morphometric abnormalities: abnormal vessel diameter, comma signs, blood sludging, boxcar blood flow phenomenon, distended vessels, damaged vessels, hemosiderin deposits, vessel tortuosity, and microaneurysms. There was a decrease in vascularity (diminished presence of conjunctival vessels) in SCD patients compared with non-SCD controls, giving the bulbar conjunctiva a "blanched" avascular appearance in most but not all SCD patients during steady-state. Averaged steady-state red cell velocity in SCD patients was slower than in non-SCD controls. During painful crisis, a further decrease in vascularity (caused by flow stoppage in small vessels) and a 36.7% +/- 5.2% decrease in large vessel (mostly venular) diameter resulted. In addition, the conjunctival red cell velocities either slowed significantly (6.6% +/- 13.1%; P <.01) or were reduced to a trickle (unmeasurable) during crisis. The microvascular changes observed during crisis were transient and reverted to steady-state baseline after resolution of crisis. When combined, intravital microscopy and computer-assisted image analysis (computer-assisted intravital microscopy) represent the availability of a noninvasive tool to quantify microvascular abnormalities in vascular diseases, including sickle cell disease. The ability to identify and relocate the same conjunctival vessels for longitudinal studies uniquely underscores the applicability of this quantitative real-time technology.
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Affiliation(s)
- Anthony T W Cheung
- Department of Medical Pathology, University of California (UC) Davis School of Medicine, Davis, CA 95817, USA.
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Roy MS, Gascon P, Giuliani D. Macular blood flow velocity in sickle cell disease: relation to red cell density. Br J Ophthalmol 1995; 79:742-5. [PMID: 7547785 PMCID: PMC505236 DOI: 10.1136/bjo.79.8.742] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS/BACKGROUND While the retinal lesions of sickle cell retinopathy have been well documented, their pathogenesis remains unclear. The purpose of this study was (1) to compare macular blood flow velocity in patients with sickle cell disease and controls, and (2) to determine in sickle cell patients the relation between macular blood flow velocity and red blood cell density. METHODS Macular blood flow velocity was measured in 18 patients with stable sickle cell disease and 45 normal controls using blue field entoptoscopy. Red blood cell density was determined by the phthalate ester density method. RESULTS There were no significant differences between patients and controls for leucocyte velocity. However, in the sickle cell patients leucocyte velocity in the macular capillaries was significantly negatively associated with greater range of red blood cell density (p < 0.002 and p < 0.04 for right and left eyes, respectively). CONCLUSION These results suggest that in sickle cell patients heterogeneity of the density of the red blood cells may slow down macular capillary blood flow.
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Affiliation(s)
- M S Roy
- Department of Ophthalmology, UMDNJ, New Jersey Medical School, Newark 07103, USA
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Rodgers GP, Noguchi CT, Schechter AN. Hemodynamic studies in sickle cell disease. Ann N Y Acad Sci 1989; 565:338-46. [PMID: 2672969 DOI: 10.1111/j.1749-6632.1989.tb24181.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
With the availability of these noninvasive imaging modalities, one can now obtain more objective information about microcirculatory pathophysiology. As a result, previously held pathophysiologic paradigms in sickle cell disease will undoubtedly require modification or abandonment. These approaches should be viewed as supplements, not substitutes, for more traditional evaluations. Nonetheless, since these techniques are amenable to sequential application, these approaches promise to define disease severity more precisely, in quantitative terms, and should provide the means to follow the results of therapy unambiguously.
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Affiliation(s)
- G P Rodgers
- Laboratory of Chemical Biology, National Institutes of Diabetes, and Digestive and Kidney Diseases, Bethesda, Maryland 20892
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Roy M, Gunkel R, Rodgers G, Schechter A. Lanthony desaturated panel D15 test in sickle cell patients. Graefes Arch Clin Exp Ophthalmol 1988; 226:326-9. [PMID: 3169584 DOI: 10.1007/bf02172960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Lanthony D15 desaturated test was used to compare color vision in sickle cell patients with 20/20 visual acuity and peripheral lesions of sickle cell retinopathy with normal controls. Sickle cell patients had significantly higher Lanthony error scores and significantly more blue-yellow and mixed color vision defects than controls. Among patients with sickle cell anemia (SS), Lanthony and Farnsworth Munsell 100 Hue test scores were significantly correlated, and both tests showed good agreement in identifying the presence or absence of a color defect. These results suggest that the Lanthony D15 test may be a useful clinical tool to identify blue-yellow color defects, especially because of its brevity and simplicity of administration.
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Affiliation(s)
- M Roy
- National Eye Institute Clinical Branch, National Institutes of Health, Bethesda 20892
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