Ultra-Widefield Retinal Imaging Versus Dilated Fundus Examination for the Detection of Sickle Cell Retinopathy: A Systematic Review and Meta-Analysis

Aim : To evaluate the diagnostic accuracy and clinical utility of UWF imaging compared with DFE in detecting and staging sickle cell retinopathy. Methods : This systematic review was registered with PROSPERO (CRD42025111099). Systematic search was done in PubMed, Embase, MEDLINE, and Cochrane Library, from their inception until the end of July 2025. This review included all studies that evaluated the diagnostic accuracy and clinical utility of UWF retinal imaging for the detection and staging of SCR. QUADAS-2 tool was used to assess the risk of bias. Meta-analysis was performed using MetaDiSc software (version 1.4). To calculate combined sensitivity, specificity, summary receiver operating characteristic (SROC) plots, and forest plots. Results : 3 studies were included in the review, 299 patients and 596 eyes. For the non-proliferative sickle cell retinopathy (NPSCR), UWF yielded a pooled sensitivity of 0.819 (95% CI: 0.732 –0.887), and specificity of 0.741 (95% CI: 0.694 –0. 783) with an area under the curve (AUC) of 0.8671. For the proliferative sickle cell retinopathy (PSCR), it demonstrated a high diagnostic efficacy, with sensitivity of 0.831 (95% CI: 0.710 –0.916), specificity of 0. 852 (95% CI: 0.816 –0.884), and an AUC of 0.9296. UWF identified a higher proportion of patients than DFE in both NPSCR (75–85% vs 60–67%) and PSCR (69–90% vs 52–53%). Conclusion: UWF imaging can be a powerful tool for early detection and monitoring of sickle cell retinopathy with a higher sensitivity than DFE. This could ultimately reduce vision loss by identifying patients who require early intervention.