Ocular Involvement Occurs in Nearly Half of Leukemia Patients

Although RVO represented just 1.2% of cases of ocular involvement in this study, the researchers found that it often presented as the first manifestation of leukemia, sometimes before a systemic diagnosis. Photo: Joseph Sowka, OD, and Alan Kabat, OD. Click image to enlarge. In a recent study, researchers from Taiwan evaluated associations between leukemia and the eye, based on eight observational studies that reported ocular findings and encompassed approximately 800 participants. Retinal hemorrhages were the most frequent finding, but retinal vein occlusion (RVO) remains a rare but serious risk as well. The findings were reported recently in Retina.The overall pooled incidence of ocular manifestations was approximately 42%, indicating that nearly half of all leukemia patients develop ocular changes at some stage of their disease. These included retinal hemorrhages, vascular occlusions, optic disc edema and vitreoretinal alterations; such findings may precede systemic relapse or serve as a surrogate marker for disease activity, the researchers suggested..The most prevalent findings were retinal hemorrhages (13% to 15%), reflecting microvascular damage secondary to thrombocytopenia, anemia and leukostasis. “Subtypes such as intraretinal and Roth spot hemorrhages indicated early hematologic instability, while macular, vitreous and subhyaloid hemorrhages represented more advanced vascular compromise,” the researchers explained in their paper. “In contrast, retinal infiltrations were less common but clinically severe, signifying direct leukemic invasion often linked with systemic relapse or central nervous system involvement.”RVO, though rare at approximately 1.2% of findings, often presented as the first manifestation of leukemia, sometimes before a systemic diagnosis, “emphasizing the importance of considering hematologic malignancies in the differential diagnosis of unexplained RVO, particularly in younger individuals or those without conventional vascular risk factors,” the authors wrote in their paper. CRVO was the most prevalent type, with bilateral involvement occurring in the majority of cases.This analysis demonstrates a multifaceted pathophysiological mechanism underlying this association. Hyperviscosity and leukostasis, common in cases of hyperleukocytosis, can hinder retinal circulation and lead to venous occlusion. Leukemic infiltration of the optic nerve or retinal vessels, in multiple cases and often confirmed by cerebrospinal fluid analysis or histopathological examination, represents another significant mechanism.The authors note that the broad age range of affected individuals, spanning from childhood to late adulthood, and the diversity of leukemia subtypes show that the association is not limited to a specific demographic or disease category.“Clinically, these findings highlight that ocular involvement serves as a sensitive biomarker of systemic disease activity,” they added. “Retinal vascular or hemorrhagic changes can precede hematologic relapse, guide timely systemic interventions and prevent vision loss.”Because of this, routine ophthalmologic screening, particularly fundus and OCT evaluation, should be incorporated into leukemia management. “Early detection and monitoring of ocular changes not only improve visual prognosis but also provide critical insights into disease progression, treatment response and systemic vascular health, reinforcing the eye’s role as a vital diagnostic window in leukemic care,” the authors concluded in their paper. Click here for the journal source. Chen K-Y, Chan H-C, Chan M-C. Leukemia and retinal vascular occlusion: a systematic review and meta-analysis of ocular manifestations and vascular complications. Retina. January 9, 2026. [Epub ahead of print.]This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.