Ocular Abnormalities in Multi-transfused Patients with Beta-thalassemia: A Cross-sectional Study from South India

This study aimed to evaluate ocular findings in transfusion-dependent beta-thalassemia patients and determine whether they exhibit a higher incidence of ocular abnormalities compared to healthy controls owing to effects of iron overload and chelation therapy.

An analytical cross-sectional study was conducted in the Departments of Ophthalmology and Pediatrics at a tertiary care center in South India. Patients aged 10-18 years with transfusion-dependent thalassemia, receiving regular blood transfusions (every 2-4 weeks for at least 2 years), were included as cases. Age- and sex-matched healthy individuals without ocular complaints served as controls. All participants underwent a comprehensive ophthalmic evaluation, including visual acuity, color vision, slit-lamp examination, dilated fundus examination, dry eye testing (tear film breakup time [TBUT] and Schirmer's), and intraocular pressure measurement. Clinical history, annual transfusion requirement, and mean serum ferritin levels were recorded for cases. Data were analyzed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY, USA) with appropriate parametric or nonparametric tests, and P < 0.05 was considered statistically significant.

Of the thalassemia patients, 65.1% were male. Retinal vascular tortuosity was observed in 14% (P = 0.026) and was significantly associated with higher serum ferritin (P = 0.004). Retinal pigment epithelium changes (9.3%) and increased cup-to-disc ratio (11.6%) showed nonsignificant trends. Tear film instability (TBUT <10 s) was present in 20.9% (P = 0.649), while Schirmer's test indicated dry eye in 18.6% (P = 0.044), both associated with elevated ferritin. Refractive errors were significantly more frequent in the case group (18.6%, P = 0.005). Lenticular opacities and Bitot's spots were found in 4.7% and 2.3%, respectively.

Ocular abnormalities are common among beta-thalassemia major patients, with some correlating with serum ferritin levels. Regular ophthalmic screening should be integrated into multidisciplinary care to facilitate early detection and management. Larger longitudinal studies are warranted to assess the progression and visual impact of these changes.