known as black sunburst spots. These oval or round shaped pigmented spots are formed due to RPE proliferation. As the haemoglobin within the hemorrhage breaks down over time, yellow spots known as iridescent bodies are formed within the layers of the sensory retina. Maculopathy occurs in a significant portion of patients affected by sickle cell retinopathy. It is more prevalent in homozygous HbSS type sickle cell disease. The fovea can be found within the macula and is known as the center of the visual field. Maculopathy in sickle cell retinopathy is due to long term changes of capillaries that interact at the fovea. Although ischemic changes may be apparent on the retina, maculopathy may be asymptomatic at first leaving visual acuity unchanged. Central retinal artery occlusion is a known feature of non-proliferative sickle cell retinopathy that has a low incidence in patients with non proliferative sickle cell retinopathy. Optic nerve sign is represented by dilated capillaries that can be visualized in the nerve using fluorescein angiography. Visual acuity often remains unchanged with this finding. Angioid streaks: Angioid streaks may be seen in up to 6% of cases. Proliferative sickle cell retinopathy (PSCR) Proliferative sickle retinopathy is the most severe ocular complication of sickle cell disease. Even though PSCR begins in the first decade of life, the condition remains asymptomatic and unnoticed until visual symptoms occur due to vitreous hemorrhage or retinal detachment. Goldberg classification Goldberg classified PSR into following 5 different self-explanatory stages: Stage of peripheral arterial occlusion and ischemia: It is the earliest abnormality that can be visualized by fundus examination. The occluded arterioles can be seen as dark red lines. They eventually turn into white silver-wire vessels. Stage of peripheral arteriolar-venular anastomoses: Arteriolar-venular anastomoses develop as blood is diverted from blocked arteries to nearby venules. Stage of neovascularization and fibrous proliferation: Neovascularization starts from the arteriolar-venular anastomoses, and grow into the ischemic retina. Characteristic fan-shaped appearance due to neovasularization is known as sea fan neovascularization. Stage of vitreous hemorrhage. Peripheral neovascular tufts bleed and cause vitreous hemorrhage. Stage of vitreoretinal traction bands and tractional retinal detachment: Traction on the sea fan and adjacent retina causes traction retinal detachment. Signs and Symptoms Comma sign: Comma shaped vessels in the bulbar conjunctiva is due to vascular occlusion of conjunctival vessels. Vitreoretinal traction or retinal detachment cause flashes, floaters or dark shadows. Sudden loss of vision may occur due to retinal