Smoking Nearly Tripled Progression Risk in Proliferative Sickle Cell Retinopathy

Sickle cell disease can block retinal vessels and lead to sickle cell retinopathy. A 10-year Wilmer Eye Institute review—described as the largest modern U.S. longitudinal cohort of its kind—found that active smoking at the time proliferative disease was diagnosed strongly predicted further progression.

Who was followed

Researchers reviewed 317 adults (620 eyes; mean age 35) seen at Wilmer between July 2013 and June 2023. Eyes had either nonproliferative disease (earlier vessel changes) or proliferative disease (abnormal new vessels that threaten vision).

Progression numbers

• About 10.7% of nonproliferative eyes advanced to proliferative disease over follow-up windows described in the paper.
• Among eyes that already had proliferative disease, about 17% showed further progression.
• Active cigarette or cigar smoking at proliferative diagnosis was linked to nearly three times the progression hazard (hazard ratio 2.78) versus nonsmokers.
• Age, sex, genotype, hydroxyurea, transfusions, and lifetime smoking history were not significant progression predictors in this analysis.

Lead author Anshuman Agrawal and principal investigator Adrienne Scott, MD, stressed that current smoking appeared more relevant than remote smoking history. Specialty-center patients may have more severe disease than average, which limits how far numbers generalize.

Why specialty centers still matter

Wilmer’s cohort may include more advanced disease than a typical community sample. Even so, the smoking signal is actionable everywhere: hematology teams and eye clinics can reinforce cessation at the same visit where they schedule imaging. Scott emphasized that many people with sickle cell retinopathy keep good vision for a long time when systemic disease and retinal monitoring stay on track.

Actionable messages

• People with sickle cell disease need retina exams starting in childhood on the schedule their hematology and eye teams recommend—often yearly from about age 10.
• Stopping cigarettes or cigars is a concrete step that may protect sight.
• A retinopathy diagnosis does not guarantee vision loss if disease and smoking are managed and exams continue.

We provide neutral education and urgent triage; active sickle cell retinopathy care is referred to retina specialists. For broader Los Angeles eye-health articles, visit los-angeles-lasik.com.

Source: Decadelong study finds smoking worsens sickle cell retinopathy (Medical Xpress (Johns Hopkins / American Journal of Ophthalmology), 09/30/2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.