Sudden unilateral visual loss as an initial presentation of chronic myelogenous leukemia

Len V Hua, Salisa K Williams

Pacific University Eye Clinic, Forest Grove, OR, USA

Abstract: Leukemia is a cancer of the white blood cells. Many patients with leukemia are  unaware of their disease until routine blood work up for other conditions reveals incidental findings leading to a diagnosis of leukemia. Up to 50% of patients with leukemia have ocular manifestations. In fact, floaters or decreased vision may be the initial symptom of leukemia.

Case study: A 51-year-old Caucasian female patient with sudden unilateral visual loss in the left eye was found to have bilateral retinal neovascularization and Roth spot hemorrhages. Blood work up and cytological analyses confirmed the Philadelphia chromosome, which has been implicated in the development of chronic myelogenous leukemia (CML). Further testing confirmed a diagnosis of chronic phase CML. After a two-month course of imatinib and close monitoring by a hematological oncologist, her vision has improved and the retinal vascularization has significantly resolved.

Conclusions: Eye care professionals are in a unique position to identify this devastating disease early on. A delay in diagnosis of the disease may lead to conversion into the acute phase, which has a poor prognosis for survival. A prompt referral to internal medicine and oncology for co-management is crucial.

Keywords: chronic myelogenous leukemia, retinal hemorrhages, Roth spot, imatinib (Gleevec^®) Philadelphia chromosome, vision loss