Teleretinal Screening Motivates Sickle Cell Patients to Seek Eye Care

Bivek Wagle MD

Credit: The Ohio State University

A significant number of patients with sickle cell anemia sought an eye care provider after receiving teleretinal screening imaging during appointments with a hematologist or oncologist, according to a new retrospective chart review study.¹

These data, presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting, indicated the effectiveness of the teleretinal screening program in motivating the decision to pursue eye care, particularly for those with more advanced stages of sickle cell retinopathy.

“Using a teleretinal screening program to raise awareness of sickle cell retinopathy, especially among patients with more advanced disease noted on screening, was effective in motivating patients to seek care,” wrote investigators led by Bivek Wagle MD, department of ophthalmology, The Ohio State University Wexner Medical Center.

Sickle cell retinopathy progression is linked to vision impairment or loss—care delays in those with early-stage retinopathy could limit their future prognosis and worsen vision. As a result, Wagle and colleagues indicated the critical nature of timely diagnosis and interventions for the retinal condition.

A collaboration between the hematology and ophthalmology departments at a major academic institution, this analysis sought to determine characteristics in patients with sickle cell disease or trait related to seeking eye care shortly after teleretinal imaging.

Factors, including a prior eye care provider, advanced stage of retinopathy, or a specific sickle cell genotype were hypothesized to influence the timeline in seeking care.

An ultrawide field fundus camera was installed in a hematology/oncology clinic. Recommendations for screening fundus imaging were implemented for new patients presenting for sickle cell anemia evaluation at the clinic.

Ophthalmologists reviewed these images, and based on the stage of retinopathy, follow-up with an eye care provider was recommended. Charts were then retrospectively reviewed to evaluate these characteristics and decide if a patient had visited an eye care provider.

The study included 264 eyes of 132 patients imaged between October 2021 and October 2023. Patients had a mean age of 35.4 years, 67 were male, and 65 were female. Aside from the teleretinal screening, a Fisher’s Exact test, Cochran Armitage trend test, and Ordinal logistic regression were used to evaluate secondary factors of patients seeking eye care.

Before teleretinal screening initiation, only 9 (6.8%) patients previously had an established eye doctor. After initiation of the novel teleretinal screening program, 115 (87.1%) patients visited an eye care provider within 3 months,

Among the screened images, 48% showed no retinopathy, 39% had non-proliferative sickle cell retinopathy, and 13% had proliferative sickle cell retinopathy.

A prior eye care provider (P = .6037) and sickle cell genotype (P = .5433) were not statistically significant with increasing compliance in referral to an eye care provider, while the stage of retinopathy (P = .0164 OD and P = .0114 OS) was significant.

Overall, investigators indicated these data demonstrate the utility of teleretinal screening imaging among patients with sickle cell anemia.

“The teleretinal screening program may be an effective tool for screening sickle cell patients and improving compliance with recommended screenings,” Wagle and colleagues wrote.

Reference

1. _{Wagle B. Utility of Teleretinal Screening Imaging Among Patients with Sickle Cell Anemia. Poster presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting. Stockholm, Sweden. July 17-20, 2024.}
2. _{Brandsen RP, Diederen RMH, Bakhlakh S, Nur E, Schlingemann RO, Biemond BJ. Natural history and rate of progression of retinopathy in adult patients with sickle cell disease: an 11-year follow-up study. Blood Adv. 2023;7(13):3080-3086. doi:10.1182/bloodadvances.2022009147}