A Study of Ocular Side Effects of Blood Transfusions and Iron Chelators in Thalassemia Patients

Abstract

Aim: To determine the ocular changes and importance of ophthalmic consults in thalassemia patients on iron chelating agents and regular blood transfusions. Settings and Design: A cross-sectional study was conducted among thalassemia patients who were on regular blood transfusion and iron chelators. Materials and Methods: A detailed history was obtained from 50 thalassemia patients included in the study including birth history, family history, and treatment history which was taken from the parents. Ophthalmic examination performed included visual acuity test for distant and near vision with Snellen chart, color vision obtained with Ishihara plates, contrast sensitivity performed with Pelli–Robson charts, Schirmer test conducted with Whatman strip, intraocular pressure obtained with Perkins tonometer, detailed anterior segment performed with Appasamy Slit Lamp biomicroscope and posterior segment examination with the aid of 90D lenses, and indirect ophthalmoscopy with 20D lenses performed after dilatation. Fundus photograph was taken for all the patients with ZEISS fundus camera. The findings were recorded and documented. Statistical Package AQ6 for the Social Sciences software was used to analyze data obtained. Results: Study group included 26 males (52%) and 24 females (48%) of varying age from 4 years up to 18 years of age. Presence of thalassemia disorder was noted in the family of 10 patients (20%). Five (10%) patients had mild visual impairment for distant vision. While, 18 patients (36%) had mild dry eye disease. Fundus abnormalities were seen in 14 patients as arteriovenous tortuosity, tessellated fundus, and desferrioxamine retinopathy. Decreased visual acuity, dry eye, and fundus abnormalities were seen in patients with serum ferritin levels >1000 ng/mL. Fundus abnormalities were seen in patients with higher serum ferritin levels (>1000 ng/mL) and longer duration of treatment. In total, ocular changes were seen in 31 patients (62%). Conclusion: Regular ophthalmic consult is necessary for all thalassemia patients on regular blood transfusion and chelation therapy to unmask ocular changes at an early stage and provide optimum visual care.