Routine Ophthalmological Examination Rates in Adults with Sickle Cell Disease Are Low and Must Be Improved

Int J Environ Res Public Health. 2023 Feb 16;20(4):3451. doi: 10.3390/ijerph20043451.

Abstract

The American Academy of Ophthalmology and the National Heart, Lung and Blood Institute recommend patients with sickle cell disease (SCD) undergo dilated funduscopic exams (DFE) every 1-2 years to screen for sickle retinopathy. There is a paucity of data on the adherence rate to these guidelines; a retrospective study was performed to evaluate our institution's adherence. A chart review of 842 adults with SCD, seen 3/2017-3/2021 in the Montefiore healthcare system (All Patients), was done. Only about half of All Patients (n = 842) had >1 DFE during the study period (Total Examined Patients, n = 415). The Total Examined Patients were categorized as screening, those without retinopathy (Retinopathy-, n = 199), or follow-up, including individuals previously diagnosed with retinopathy (Retinopathy+, n = 216). Only 40.3% of screening patients (n = 87) had DFE at least biennially. As expected, there was a significant decrease in the average DFE rate of the Total Examined Patients after the COVID-19 pandemic started (13.6%) compared to pre-COVID (29.8%, p < 0.001). Similarly, there was a significant decrease in the screening rate of Retinopathy- patients from 18.6% on average pre-COVID to 6.7% during COVID (p < 0.001). This data shows the sickle retinopathy screening rate is low and innovative approaches may need to be employed to remedy this issue.

Keywords: screening; sickle cell disease; sickle cell retinopathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anemia, Sickle Cell*
  • COVID-19*
  • Humans
  • Pandemics
  • Retinal Diseases* / diagnosis
  • Retinal Diseases* / epidemiology
  • Retrospective Studies

Grants and funding

The work of the first author herein was supported by a $2500 research fellowship stipend for medical students from the Office of Medical Student Research at the Albert Einstein College of Medicine.