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Ultra-Widefield Retinal Imaging versus Dilated Fundus Examination for the Detection of Sickle Cell Retinopathy: A
Mohammad A Hazzazi1,2,3, Hanan T Aljadani2,4, Wasan M Alshareef2,4
1Department of Surgery, Division of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Purpose:
To evaluate the diagnostic accuracy and clinical utility of ultra-widefield (UWF) imaging compared with dilated fundus examination (DFE) in detecting and staging sickle cell retinopathy (SCR).
Patients And Methods:
This systematic review was registered with PROSPERO (CRD42025111099). A systematic search was done in PubMed, Embase, MEDLINE, and Cochrane Library until the end of July 2025. This review included all diagnostic accuracy studies that evaluated UWF retinal imaging for the detection and staging of SCR compared to DFE. Risk of bias was assessed using QUADAS-2 tool. Results were synthesized narratively following SWiM (Synthesis Without Meta-analysis) guidelines using ranges of estimates and direction of effect.
Results:
Three studies were included in the review, comprising 299 patients and 596 eyes. Two studies reported quantitative diagnostic accuracy data. For the non-proliferative sickle cell retinopathy (NPSCR), UWF demonstrated a sensitivity of 75-85% and a specificity of 62-87%. DFE demonstrated lower sensitivity (60-67%), yet it had slightly higher specificity (88% to 91%). For the proliferative sickle cell retinopathy (PSCR), UWF demonstrated a high diagnostic efficacy, with sensitivity (69-90%) and specificity (78-100%). DFE demonstrated lower sensitivity (52-53%), while its specificity was notably higher (96-98%). Across all included studies, the direction of effect consistently favored UWF imaging, which detected a higher proportion of proliferative disease and advanced Goldberg stages than DFE.
Conclusion:
UWF imaging can be a powerful tool for early detection and monitoring of SCR with a consistently higher sensitivity than DFE, particularly at proliferative stages. This could ultimately reduce vision loss and prevent complications by identifying patients who require early intervention. However, results are limited by the small number of available studies and reliance on narrative synthesis. Further high-quality prospective studies are required to confirm the clinical impact and role of UWF imaging in routine screening for SCR.
