By Linda Conlin, ABOC, NCLEC

While accompanying a young patient for an eye exam, it was my pleasure to meet Dr. Scott during her rounds at Wilmer Eye Institute in Baltimore. She is the chief of the Wilmer Eye Institute – Bel Air and associate professor of ophthalmology and vitreoretinal surgeon at the Wilmer Eye Institute, Johns Hopkins University School of Medicine. Dr. Scott’s research focus is the application of novel retinal imaging technology to evaluate and screen patients with sickle cell disease with the goal of reducing vision loss from sickle cell retinopathy. Dr. Scott is the immediate past Wilmer Retina fellowship training program director and currently serves as the medical director of the Wilmer Bel Air clinic, and graciously spoke with me about her work and career.

Linda Conlin: Why did you choose the challenging field of retinal disease and sickle cell retinopathy in particular?
Dr. Scott: I was initially interested in pediatric ophthalmology or glaucoma until I had the opportunity to work in retina. I found the innovations, imaging, diverse cases and pathologies, as well as the unique capability to learn about a patient’s systemic health through examining their retina, to be what I wanted to do. I then had an opportunity to work with Morton Goldberg, M.D., who built the sickle cell retinopathy program and through his prior research developed the staging system for sickle cell retinopathy. Through that work, I re- imagined better care for those patients with the newer imaging available.

You advocate patient-centered care. Please describe what that means.
My job is to make sure each patient can achieve their best possible eye health. I try to understand the patient’s vision health needs, to see each patient in the context of the of their overall lifestyle and daily activities.

You are a mentor with the Wilmer Diversity Scholars Program. Please describe the program.
The program is a collaboration with Wilmer faculty to offer research and mentorship opportunities to medical students from traditionally underrepresented backgrounds, with the goal of making ophthalmology a more accessible career through mentorship, training, research and exposure to the specialty.

During your career, many individuals may have helped you along the way. Who had the greatest impact on you?
My mother. She was an educator and English professor for over 50 years. She encouraged academic excellence and instilled in us a lifelong love of reading, teaching and learning.

In the NIH Pearls of Wisdom series, you said that you were able to forge your own path. How?
I realized rather late in my medical school training that I wanted to pursue ophthalmology. I didn’t have contacts or experience in the field, which is particularly competitive. As a student, I cold-called Wills Eye Institute for a position as a research assistant and spent time with a glaucoma specialist. I figured it out on my own and went for it!

How does sickle cell affect the eye, and what should opticians be aware of?
Most sickle cell patients have good vision until the later stages because problems with abnormal growth of blood vessels begin in the peripheral retina. An annual dilated eye exam is imperative. Floaters can be a symptom, so referral for dilated exam is important if a patient experiences these symptoms.

How is sickle cell retinopathy treated, and are outcomes better if it’s caught early?
Laser treatments are effective when abnormal blood vessels grow, and anti-VEGF medicines can regress blood vessels. A vitrectomy may be needed. Outcomes are better with early treatment to prevent progression to vitreous hemorrhage and/or retinal detachment in later stages.

Are there similarities between sickle cell and other anemias?
Sickle cell is unique in that it causes chronic and repetitive pain crises and can result in damage to almost every organ in the body.

You have written about social determinants and engagement to eliminate eyecare disparities. How do they affect those with sickle cell disease?
Sickle cell disease is the ultimate health care disparity. Fortunately, there are exciting newer medications and therapies to treat sickle cell disease, including gene therapies and bone marrow transplantation. Unfortunately, because of health care disparities including access to health care and medical resources, many patients with sickle cell disease may not be able to receive these treatments.

What sickle cell retinopathy studies are you conducting or planning?
Our team is currently studying changes in the retinal circulation before and after various treatments with imaging that shows the changes in real time.

Despite being far more common than several other inherited diseases, sickle cell does not receive commensurate funding. How can that change?
Awareness of these funding disparities is critical. Increased federal and foundational research funding, as well as philanthropic investment in research, is important to help clinicians and researchers work to better understand sickle cell disease and to prevent complications from the disease, such as visual impairment and blindness from sickle cell retinopathy.

How can eyecare professionals better serve individuals coping with sickle cell and other retinal diseases?
Many patients living with sickle cell disease feel that their complaints aren’t heard. It’s important to LISTEN and have a low threshold for referral for dilated retinal exams if a patient experiences visual changes, such as floaters. Always encourage annual dilated exams for susceptible people.

Thank you, Dr. Scott!