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Alessa Crossan, Shlomit Sandler, Wen-Jeng (Melissa) Yao; The prevalence of primary open angle glaucoma among sickle cell patients in the Bronx. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4275.
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Little in the literature links sickle cell disease with an increased prevalence of open angle glaucoma, despite shared ischemic pathophysiology. Our study attempts to determine the prevalence of glaucoma in patients with sickle cell disease in an inner city population and to identify whether these patients have greater prevalence of glaucoma than non sickle cell patients.
A retrospective chart review of patients seen at Montefiore Ophthalmology Department between 2003 and 2013 was done using Clinical Looking Glass, an electronic medical record that records all clinical encounters at Montefiore. Using ICD-9 codes, patients with sickle cell disease or SC disease were identified. Of these sickle cell disease patients, those with primary open angle glaucoma were extracted by ICD-9 code. The charts of the patients identified with both sickle cell disease and primary open angle glaucoma were reviewed, to identify patients with actual glaucomatous visual field loss.
We identified 375 unique patients seen by our eye department from 2003 to 2013 with sickle cell disease; of these, 52 patients also carried a glaucoma related ICD code. Of the 52 patients, 17 were identified as glaucoma suspects due to increased cup to disc ratio and had at least one humphrey visual field that was completely full and reliable. Nineteen patients were identified as glaucoma suspects based on cup to disc ratio but never followed up for a visual field. Four patients had at least one HVF that could have been indicative of glaucomatous field loss. Our calculated prevalence of glaucoma in this sickle cell population was 1.1%; the average age of these 52 patients was 28.
In our inner city population with numerous African American patients, we identified 52 patients with sickle cell or SC disease and primary open angle glaucoma. Four patients had increased cup to disc as well as one HVF that could be indicative of glaucomatous field loss, giving a prevalence of 1.1%. This is lower than historically quoted rates in the Baltimore and Barbados eye studies, possibly secondary to the younger age of our sickle cell patients compared to usual glaucoma patients. Further study is necessary to clarify whether the ischemic changes of sickle cell disease have any association with increased prevalence of POAG.
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