Letter to the Editor: Eye as a window to disease burden in pediatric acute leukemia

Ocular involvement in pediatric acute leukemia is an increasingly recognized, clinically relevant manifestation, but prevalence and patterns vary. It may arise from direct leukemic infiltration or secondary hematologic abnormalities. Recent observational studies, including Eastern India cohorts, underscore systematic ophthalmic evaluation at diagnosis. In a cohort of 47 children by Parija et al published in the World Journal of Experimental Medicine, ocular findings were present in 40.4% at presentation; most were asymptomatic and retinal hemorrhages predominated. Other series report similar patterns, with retinal hemorrhages common and prevalence roughly 40%-45%, while pooled meta-analytic estimates suggest an overall prevalence near 20%, differences likely reflect ethnicity, healthcare access, diagnostic protocols, study design, and sample size. Hematologic factors such as anemia and thrombocytopenia favor hemorrhagic lesions, whereas marked leukocytosis and high blast counts associate with infiltrative involvement of the retina, optic nerve, or orbit. Although some studies link ocular involvement to higher disease burden and worse outcomes, evidence is inconsistent because of methodological limitations and short follow-up. These findings support routine baseline ophthalmic screening, even in asymptomatic children, to detect vision-threatening lesions and clearly inform risk assessment. Larger prospective studies with standardized ocular and hematologic correlations are needed to define prognostic significance and optimize screening.