Screening for sickle cell retinopathy: A comparison of systematic angiography and ultra-widefield imaging

Sickle cell disease is a prevalent genetic hemoglobinopathy affecting approximately 120 million people worldwide. Fluorescein angiography in the seven ETDRS fields is currently the gold standard for detecting proliferative forms of retinopathy, but ultra-widefield imaging (UWF) may represent a non-invasive alternative. We sought to compare the two screening strategies implemented in the Centre-Val de Loire region: systematic 7-field ETDRS fluorescein angiography at the University Hospital of Orléans versus non-angiographic ultra-widefield imaging (Optos©) at the University Hospital of Tours.

We conducted a retrospective, multicenter, non-inferiority cohort study. Retinopathy staging was based on the local imaging strategy. Sensitivity and specificity of UWF imaging for detecting stage III SCR (preretinal neovascularization) were evaluated. A budget impact analysis assessed the economic implications of each approach.

UWF imaging detected four times fewer stage III cases than fluorescein angiography (adjusted OR=0.25 [0.11-0.52]). Nevertheless, UWF demonstrated high diagnostic performance, with a sensitivity of 93% and a specificity of 100%. Budgetary analysis revealed substantial cost savings with UWF imaging. No increase in the incidence of advanced stages (IV or V) was observed in the UWF group, suggesting no detrimental clinical consequences.

UWF imaging is a safe, reliable, and cost-effective alternative for screening for proliferative SCR. Its non-invasive nature and high sensitivity support its use as a first-line tool. Close monitoring of early or borderline neovascular lesions, which may spontaneously regress, may help to optimize the indications for laser photocoagulation while reducing the need for systematic angiography.