In this study, we demonstrate the use of wide-field photography and fluorescein angiography to visualize the peripheral vascular changes and to identify patients with risk factors for developing proliferative sickle cell retinopathy.
This is a retrospective case series of 12 eyes of 6 patients with sickle cell disease. Visual acuity testing, slit-lamp biomicroscopy, dilated fundus examinations, and noncontact wide-field fundus photography and fluorescein angiography using Optomap scanning laser ophthalmoscope (Optos, Marlborough, MA) were performed in all patients. The retinopathy was classified into proliferative and nonproliferative retinopathies, and the extent of retinopathy was measured in degrees. Wide-field images obtained using Optomap were compared with the derived seven-standard field images.
At the time of initial examination, 50% of the total eyes had proliferative retinopathy. All the peripheral retinas and vasculature were easily imaged within a single frame with Optomap. Six eyes met the high-risk criteria for developing proliferative changes. None of the eyes in our case series had tractional retinal detachment. The degrees of any type of sickle cell retinopathy and active neovascularization ranged from 20° to 360° and 10° to 60°, respectively. In all but one eye, wide-field images detected peripheral vascular changes missed on the seven-standard field photographs.
Wide-field fluorescein angiography and color photography enhance clinicians' ability to visualize peripheral vascular remodeling in sickle cell disease and to identify high-risk characteristics for proliferative sickle cell retinopathy.
Wide-field imaging may improve the visualization of peripheral vascular changes that develop in sickle cell hemoglobinopathies. This system has a higher sensitivity than clinical ophthalmoscopy and can aid in identifying factors that place patients at a higher risk for proliferative sickle cell retinopathy.
From the Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
The authors have no proprietary or conflicts of interest to disclose.
Reprint requests: Szilárd Kiss, MD, Department of Ophthalmology, Weill Cornell Medical College, 1305 York Avenue, 11th Floor, New York, NY 10021; e-mail: email@example.com