Retinal imaging options for differentiating degenerative retinoschisis from retinal detachment: A scoping review

Degenerative retinoschisis (RS) can mimic retinal detachment (RD), posing a diagnostic challenge. We summarize the utility and limitations of current retinal imaging modalities in evaluating degenerative RS. We conducted a systematic search of PubMed, Embase, Scopus, Cochrane Library, and Google Scholar from January 1, 1973, to February 5, 2025. Studies evaluating imaging modalities in degenerative RS were reviewed, including spectral-domain OCT (SD-OCT), B-scan ultrasound (US), ultrasound biomicroscopy (UBM), fundus autofluorescence (FAF), infrared reflectance (IR), OCT angiography (OCTA), and color doppler ultrasound (CDUS). Twenty-two studies met inclusion criteria. SD-OCT remains the most reliable modality, providing high-resolution layer differentiation and detection of schisis-detachment, though its peripheral reach is limited. B-scan ultrasonography and UBM can overcome this limitation and are particularly useful in cases with media opacity. where FAF and IR imaging yield inconsistent and non-reproducible results, limiting their diagnostic utility. CDUS and CEUS may offer additional diagnostic value, particularly in perfusion-based differentiation of RS from RD, though they remain underexplored in schisis-detachment. OCTA is useful in characterising the vascular abnormalities seen in RS; its added B-scan capability may offer advantages over UBM in select cases. We apply the use of different multimodal imaging approaches to cases with diagnostic uncertainty, and apply the use of new imaging options for cases where OCT was unavailable. A multimodal imaging approach is recommended in diagnostically uncertain cases of degenerative RS. Larger prospective studies are needed to validate newer modalities, particularly in schisis-detachment.