Retinal Signs May Precede Leukemia Diagnosis

A new meta-analysis reports that approximately 42% of patients with leukemia demonstrate ocular involvement, most commonly retinal hemorrhages, which may precede systemic diagnosis. Findings across 1,016 patients suggest vascular, hematologic and infiltrative mechanisms contribute to disease. Authors highlight the importance of routine ophthalmic screening, including fundus examination and OCT, to enable early detection and improve visual and systemic outcomes. Photo: eyerounds.org/Eric Chin, MD. Click image to enlarge. It’s well-established that conditions such as diabetes, systemic hypertension and hyperlipidemia are associated with retinal vein occlusion (RVO), and further evidence is emerging regarding its contribution to the risk of cerebrovascular accidents and myocardial infarction, among others. Researchers are also exploring if hematologic malignancies, including leukemia, could also be involved in the development of RVO. A new study published in Retina concluded that nearly half of patients with this type of cancer have ocular involvement that often precedes systemic symptoms, putting an emphasis on screening guidelines and interdisciplinary care.  Included in the systematic review and meta-analysis were eight studies encompassing 1,016 participants across diverse geographic regions, including India, Nigeria, Pakistan and the US. According to the results, 42% of patients with leukemia exhibited ocular manifestations. Retinal hemorrhage was the most frequent finding (13% to 15%), followed by retinal infiltration (3%) and retinal vein occlusion (1.2%).  The authors wrote, “This finding suggests that nearly one in seven patients with leukemia experiences retinal hemorrhagic changes, signifying that vascular and hematologic abnormalities play a critical role in leukemic ocular involvement.” Such findings, they noted in their paper, “were among the earliest and most frequent ocular indicators of leukemia.” This analysis demonstrates a multifaceted pathophysiologic mechanism underlying this association, they continued. “Hyperviscosity and leukostasis, common in cases of hyperleukocytosis, can hinder retinal circulation and lead to venous occlusion,” wrote the authors. “Leukemic infiltration of the optic nerve or retinal vessels, in multiple cases and often confirmed by cerebrospinal fluid analysis or histopathologic examination, represents another significant mechanism.”Visual outcomes among study subjects ranged from complete visual loss to partial or substantial recovery after leukemia-directed therapy,” they continued. “This variation suggests that early recognition and prompt systemic treatment may improve ocular prognosis in selected cases.”Clinically, these findings underscore that ocular manifestations are not uncommon and may precede, parallel or reflect systemic disease activity. “The findings confirm that although RVO is uncommon in leukemia, it is a marker of advanced hematologic derangement, especially in cases with elevated leukocyte counts or coagulopathy,” wrote the authors in Retina, advocating for routine screening of at-risk patients. “Early recognition of retinal vascular involvement can prompt timely systemic therapy adjustments and prevent irreversible vision loss.”Researchers noted some limitations, including the variability in study design, population characteristics and diagnostic methods among the studies used. Additionally, the predominance of single-center and hospital-based cohorts may have limited the generalizability of the results, they wrote, and the lack of uniform diagnostic criteria for ocular manifestations across studies made it difficult to ensure consistency in outcome measurements. Despite these limitations, the authors believe that this study provides the most comprehensive quantitative estimate to date of ocular involvement in leukemia. “Collectively, the findings highlight that ocular signs serve as vital, noninvasive biomarkers of systemic leukemic activity, reinforcing the need for multidisciplinary collaboration between hematologists and ophthalmologists to improve prognosis and preserve visual function,” they concluded.Click here for the journal source. Chen KY, Chan HC, Chan CM. Leukemia and retinal vascular occlusion: A systematic review and meta-analysis of ocular manifestations and vascular complications. Retina. April 28, 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.