Abstract
Purpose :
The American Academy of Ophthalmology (AAO) and the National Heart, Lung, and Blood Institute (NHLBI) suggest sickle cell patients undergo dilated funduscopic exams (DFE) every 1-2 years to screen for sickle cell retinopathy, but there is a paucity of research reporting whether such guidelines are followed in the sickle cell disease (SCD) population. A retrospective study was performed to assess whether adults with SCD at our institution are adhering to the recommendations.
Methods :
This study is a chart review of 842 adult patients with sickle cell diagnosis, seen from 3/17 – 3/21 by internists in the Montefiore healthcare system. Data was collected through the Electronic Medical Record (EMR) of patients with a DFE categorized as normal (Retinopathy -, n = 216) or with retinopathy (Retinopathy +, n = 199). A regular DFE was defined as at least one DFE every 2 years. Screening rates were calculated by removing patients with retinopathic disease noted in EMR from total SCD patients. Yearly DFE rates were calculated from March to March, since COVID-19 was declared a global pandemic in March 2020. Two-tailed Student’s t-test was used for statistical analysis of continuous data, Fisher’s exact test for categorical data, and two-sample proportion test for comparison of yearly exam rates.
Results :
The Retinopathy - group was younger (p<0.001) and contained less SC genotype (p<0.001) compared to Retinopathy +. 40.3% of the Retinopathy - patients were screened regularly (n = 87), whereas 59.7% had irregular screening (n = 129). There was a significant decrease in the total rate of all patients with DFEs, comparing the average rate of 29.8% pre-COVID (3/17-3/20) to 13.6% during COVID (3/20-3/21) (p<0.001). Similarly, the screening rate for non-retinopathic patients decreased from an average rate of 18.6% pre-COVID to 6.7% during COVID (p<0.001).
Conclusions :
The results demonstrate that our rate of routine dilated fundoscopic examination for SCD patients is very low. These low rates were even more adversely affected by the onset of the COVID-19 pandemic, as clinics closed and access to physicians decreased. Screening rates need to be increased by patient involvement and education, easier access to ophthalmologists and novel ways of screening for retinopathy (e.g. annual screening fluorescein angiograms) to reduce risk of blindness in these patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.