Retinal biomarkers associated with iron deficiency anemia and beta-thalassemia in children

Aim: to study retinal parameters in children with iron deficiency anemia (IDA) and beta-thalassemia (BT) by optical coherence tomography-angiography (OCTA) and to identify biomarkers of preclinical retinopathy (PR). Materials and Methods: 90 children, 36 boys and 54 girls aged 7–18 years old (30 healthy volunteers (controls), 30 patients with IDA and 30 patients with BT major without ophthalmoscopic signs of retinopathy), were examined. Design: a prospective observational single-step case- control study. A standard ophthalmological examination, OCTA, and hematological parameter assessment were performed. Results: children with IDA demonstrated a significant decrease in circularity index (CI) of foveal avascular zone (FAZ) and vascular density (VD) of the superficial retinal capillary plexus (SRCP) to 0.5±0.05 (p<0.001) and 37.3±0.95% (p=0.001), respectively, as compared with controls (0.63±0.05 and 38.5±1.1%, respectively) that may highlight retinal microcirculatory changes without ophthalmoscopic signs of retinopathy. FAZ CI is the most sensitive biomarker of PR in children with IDA (cut-off value — 0.55; sensitivity — 73.33%, specificity — 70%). Children with BT without ophthalmoscopic signs of retinopathy showed an increase in FAZ area (0.34±0.09 mm2; p=0.001) and perimeter (2.7±0.48 mm; p=0.001); a decrease in FAZ CI (0.45±0.06 RU; p<0.001), SRCP VD (36.15±1.69%; p<0.001) and DRCP (deep retinal capillary plexus) VD (39.03±2.61%; p=0.003) as compared with controls (0.27±0.05 mm2; 2.35±0.44 mm; 0.63±0.05 RU; 38,5±1,1%; 41,29±1,87%). This indicates more pronounced retinal microcirculatory changes than those associated with IDA. SRCP VD was the most sensitive biomarker of PR in children with BT (cut-off value — 37.5%; sensitivity — 76.67%, specificity — 83.3%). Conclusion: OCTA revealed retinal microcirculatory changes in children with anemia without ophthalmoscopic signs of retinopathy. In patients with IDA and BT major, decreased FAZ CI and SRCP VD, respectively, may be biomarkers of PR. To minimize risks of clinical manifestation of retinopathy in these patients, retinoprotective therapy based on a complex of retinal water-soluble polypeptide fractions, added to stabilization of hematological parameters, seems to be a promising approach which requires further research. KEYWORDS: optical coherence tomography-angiography, iron deficiency anemia, beta-thalassemia, biomarkers, preclinical retinopathy, retinoprotection, retinalamin. FOR CITATION: Yanchenko S.V., Saidova N.F., Malyshev A.V., Khairova E.N., Teshaev Sh.Zh., Odilova G.R., Davlatov S.S. Retinal biomarkers associated with iron deficiency anemia and beta-thalassemia in children. Russian Journal of Clinical Ophthalmology. 2026;26(1):45–51 (in Russ.). DOI: 10.32364/2311-7729-2026-26-1-7

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