Anemia Retinopathy

Anemia Retinopathy
SYMPTOMS Typically asymptomatic
May report Central vision loss and Metamorphopsia in the presence of cystoid macular edema, Central vision loss and Peripheral vision loss in the presence of optic neuropathy
SIGNS Typically bilateral
Dot/blot hemorrhages, Flame hemorrhages, Cotton wool spots, Exudates, Roth spots, Venous/venule tortuosity, Retinal capillary nonperfusion, Cystoid macular edema, Optic neuropathy (more often seen in patients with anemia due to vitamin B12 or folate deficiency)
WORK-UP Pupils, EOMs, Full eye exam with dilated retinal exam, OCT analysis of the macula (signs of cystoid macular edema are best seen with an OCT), OCT analysis of the optic nerve, OCT-Angiography, Fluorescein Angiography, Fundus photos, Watzke-Allen test, Macular photostress test, Amsler grid
TREATMENT Give take home Amsler grid in order to monitor for change
Patient needs to follow up with their primary care provider in order to diagnose, evaluate, and treat the anemia
Refer to a retinal specialist ASAP if the patient presents with cystoid macular edema associated with anemia retinopathy
FOLLOW-UP If there is no evidence of retinopathy, patient should be seen back in 12 months
If there is evidence of retinopathy, patient should be seen back in 3-6 months
If macula is stable following treatment by retinal specialist, patient should be seen back in 3-4 months
ADDITIONAL LAB | TESTS The patient needs to follow-up with their PCP for additional testing if not already done which includes the following: CBC with differential (additional testing may be needed in order to identify etiology of anemia)
ETIOLOGY Low oxygen levels lead to retinal hypoxia and increased retinal capillary permeability
DIFFERENTIAL DX Diabetic retinopathy, Hypertensive retinopathy, Sickle cell retinopathy, HIV retinopathy, Leukemia retinopathy
NOTES Low hematocrit is highly associated with development and severity of anemia retinopathy
Anemia retinopathy is more commonly found in patients with thrombocytopenia
Anemia Retinopathy: Fundus photo demonstrating peripheral Roth spots that can be seen in patients with anemia retinopathy