Evaluation of macular and optic disc radial peripapillary vessel density with optical coherence tomography angiography in cases with iron deficiency anemia

Background: Iron deficiency anemia (IDA), the most common form of anemia, may contribute to retinal microvascular alterations. Aim and objectives: To evaluate retinal vascular density (VD) in IDA patients using optical coherence tomography angiography (OCTA), before and after 3 months of iron therapy. Subjects and methods: This cross-sectional case-control study was conducted at the Ophthalmology Department, Benha University Hospital, from Nov 2022 to Oct 2023 that included two groups. Group A (study group): 24 eyes from cases with IDA, examined by OCTA before and after 3 months of treatment. Group B (control group): 24 eyes from healthy individuals. Results: At baseline, SCP VD was significantly reduced (P < 0.05) in most macular regions in IDA cases, except at the fovea and nasal perifovea (P > 0.05). DCP VD showed no significant difference in most regions (P > 0.05). RPC VD was significantly reduced (P < 0.05) in all areas except inside the disc wasn't significantly different (P > 0.05). Following 3 months of treatment, there was a significant increase (P < 0.001) in Hb, MCV, serum iron, and ferritin, and significant decrease in TIBC. SCP VD significantly improved (P < 0.05) in all regions except the fovea (P > 0.05). DCP VD showed significant recovery in most areas (P < 0.05. Conclusion: Retinal microvascular changes in IDA, including reductions in SCP, DCP, and RPC, appear to be reversible following iron treatment. OCTA may serve as a valuable tool in detecting early retinal ischemia prior to clinical retinopathy in IDA cases.