Symptom management may include behavioral, psychological and pharmacological therapies. Pharmacological intervention is reserved for more severe symptoms, while psychotherapy or cognitive behavioral therapy (CBT) may ameliorate depression and social isolation, and improve family support. The decision to use behavioral or pharmacological treatment is "usually made after the educational and supportive interventions have been in place for a period of months, and it is clear that the tic symptoms are persistently severe and are themselves a source of impairment in terms of self-esteem, relationships with the family or peers, or school performance". Psychoeducation and social support
Knowledge, education and understanding are uppermost in management plans for tic disorders, and psychoeducation is the first step. A childs parents are typically the first to notice their tics; they may feel worried, imagine that they are somehow responsible, or feel burdened by misinformation about Tourettes. Effectively educating parents about the diagnosis and providing social support can ease their anxiety. This support can also lower the chance that their child will be unnecessarily medicated or experience an exacerbation of tics due to their parents emotional state.People with Tourettes may suffer socially if their tics are viewed as "bizarre". If a child has disabling tics, or tics that interfere with social or academic functioning, supportive psychotherapy or school accommodations can be helpful. Even children with milder tics may be angry, depressed or have low self-esteem as a result of increased teasing, bullying, rejection by peers or social stigmatization, and this can lead to social withdrawal.
Visual acuity and intraocular pressure assessments can also yield results that are diagnostic of sickle cell retinopathy. Differential diagnosis
Sickle cell retinopathy should be differentiated from other retinal conditions that arise due to similar pathologies. The following differentials are classified by those pathologies. Additional causes of macular ischemiaDiabetic retinopathy
Retinal embolization (talc retinopathy, internal carotid artery embolism)
Retinal vascular occlusion
Infectious retinopathyInflammatory diseases leading to ischemiaSarcoidosis
Retinal vasculitis
Intermediate uveitis
Acute retinal necrosisAlternative causes of ischemic vascular diseaseProliferative diabetic retinopathy
Central retinal vein occlusion
Branch retinal vein occlusion
Ocular ischemic syndromE
Radiation retinopathy
Retinopathy of prematurityUnclassified causesIncontinentia pigmenti
Autosomal dominant vitreoretinochoroidopathy
Chronic rhegmatogenous retinal detachment
Scleral buckle
Retinitis pigmentosa

Prevention
Screening
Screening is an important pillar of prevention of sickle cell retinopathy as it provides the benefit of early detection and treatment thus reducing complications. Screening also provides an opportunity for education of families predisposed to retinopathy as a result of a family history of sickle cell disease. Screening can take the form of DNA screening at birth and Ophthalmology-related examinations later in life. DNA screening in newborns at risk of having sickle cell disease allows the early diagnosis of the disease. Families can then be educated on the possible effects of sickle cell disease at each stage of life. Ophthalmology-related examinations - dilated fundoscopic examination is recommended from the age of 10 and biannually thereafter in patients with no abnormal retinal findings. Fluorescein angiography and angioscopy is recommended for patients with abnormal findings that may be indicative of proliferative sickle cell retinopathy. The frequency of follow up appointments is determined by the ophthalmologist based on the severity of the findings.