Abstract
Purpose :
Currently, screening guidelines for sickle cell retinopathy require a dilated fundus exam (DFE). As neovascularization (NVE) is found in the peripheral retina, it may be missed on DFE. Our study compares the identification of NVE by DFE and fluorescein angiogram (FA) in the same patient.
Methods :
This is a retrospective chart review of sickle cell patients (N=146) at Montefiore Medical Center (Bronx, New York) between 2016 and 2021. Inclusion criteria: Adult sickle cell patients who have had at least one fluorescein angiogram (FA) and a DFE within six months. Electronic Medical Records were used to identify NVE on DFE and FA reports. Sensitivity and specificity of DFE were calculated to compare to FA. McNemar’s test was applied to compare sensitivities of DFE and FA. A kappa coefficient was calculated to compare the agreement of the two tests. Fisher’s exact test was used to compare the proportion of patients with NVE across genotypes.
Results :
146 patients met the inclusion criteria. The patient population was predominantly Non-Hispanic Black or African American (75.3%) and a majority female (64.4%). 52.1% of the population had the SS genotype, 37.0% had the SC genotype, and 10.9% were classified as Other (Sß+/Sß0). The average age was 43, with a range from 18 to 74.
Nearly half of the patients had NVE on FA, which was significantly higher than on DFE (49.3% vs.15.8% respectively, p < .001). This correlates to a sensitivity of 31.9% and a specificity of 96.0% for DFE. The p-value for McNemar’s test was <0.001, indicating that FA is significantly more sensitive than DFE. The agreement between DFE and FA was poor, with a kappa coefficient (95% CI) of 0.2813 (0.1605,0.4622).
SC patients were found to have significantly more NVE on FA than SS patients (71.2% vs. 36%, p < .001). The detection rate of NVE on DFE was higher in SC patients than in SS patients (37.8% vs. 25.9%).
Conclusions :
Our small, single-center study suggests that FA is a better approach to identifying NVE than DFE in sickle cell patients. This would be clinically important as subsequent treatment with laser therapy, anti-VEGF treatment, or observation with closer follow up typically depends on identification of NVE. Our findings highlight an important improvement in identifying NVE, but more research is required to establish routine FA as part of standard guidelines.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.