Peripapillary nerve fiber layer in patients with iron deficiency anemia: A cross-sectional study in a tertiary eye care center in Central India

AIMS: The aim of this study is to evaluate the effect of iron-deficiency anemia (IDA) on peripapillary retinal nerve fiber layer (RNFL) thickness using spectral-domain optical coherence tomography (SD-OCT). SETTINGS: The study was conducted at tertiary eye care center in Central India. DESIGN: This study was a prospective, cross-sectional, case–control, and observational study. MATERIALS AND METHODS: In the present study, 58 eyes of patients with IDA were compared with 58 eyes of healthy individuals. All individuals underwent a thorough hematological, clinical, and ophthalmic examination, followed by peripapillary RNFL analysis using SD-OCT. RESULTS: A total of 116 eyes were included in the study. The average RNFL thickness (RNFLT) in the cases was 97.26 ± 5.96, and 102.32 ± 6.26 (P = 0.005) in controls. There was a significant RNFL loss in the temporal (66.76 ± 6.1, P = 0.02), superior (119.66 ± 10.47, P = 0.01), nasal (73.59 ± 9.52, P = 0.003), and inferior (129.05 ± 10.96, P = 0.001) quadrants in the cases and controls. Serum hemoglobin, iron, ferritin, total iron-binding capacity, and transferrin saturation were lower in the cases (P < 0.05). A positive correlation was observed between average RNFLT and hemoglobin (r = 0.321), iron (r = 0.122), ferritin (r = 0.152), and transferrin (r = 0.190) levels. CONCLUSIONS: In patients with IDA, RNFLT was decreased in all quadrants compared to normal healthy individuals. The inferior and nasal RNFL showed a significant decrease in thickness. The presence of myopia, glaucoma, and diabetic and hypertensive retinopathy can exert an additive effect in the thinning of RNFLs and cause significant visual loss; hence, the correction of anemia is essential. There is a pressing need to raise public and health professional awareness of these problems and their prevention, diagnosis, and management.