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Updated: Apr 11, 2026

Evaluation of Capillary and Other Vessel Contribution to Macular Perfusion Density Measured with Optical Coherence Tomography Angiography

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Published on: February 18, 2022

Using OCT Angiography to Predict Diabetic Retinopathy Progression and Vision Decline in a Multiethnic Cohort.

Qianhui Yang^1,2, Kelvin Y C Teo^2,3,4, Yueheng Hong²

¹Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.

Ophthalmology Science

|April 10, 2026

Summary

Optical coherence tomography angiography (OCTA) can predict diabetic retinopathy (DR) progression and visual acuity (VA) decline. Enlarged foveal avascular zone (FAZ) and increased large-vessel vessel density (VD) are key predictors in patients with diabetes.

Keywords:

Cohort study Diabetic retinopathy OCTA Prediction Progression

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Area of Science:

Ophthalmology
Diabetology
Medical Imaging

Background:

Diabetic retinopathy (DR) is a leading cause of vision loss in patients with diabetes.
Early detection and prediction of DR progression are crucial for timely intervention.
Optical coherence tomography angiography (OCTA) offers non-invasive visualization of retinal vasculature.

Purpose of the Study:

To assess if baseline retinal and choriocapillaris (CC) vascular features from OCTA can predict DR progression or visual acuity (VA) decline.
To evaluate the predictive performance of OCTA metrics in a multiethnic longitudinal cohort of diabetic patients.

Main Methods:

A prospective longitudinal cohort study included 309 eyes from 192 patients with type 2 diabetes.
Swept-source OCTA imaging was performed at baseline to quantify vascular parameters (VD, PD, CC flow deficit).
Logistic regression and AUC analyses were used to determine predictors of DR progression and VA decline over 2 years.

Main Results:

Over 2 years, 15.9% of eyes showed DR progression.
Predictors of DR progression included larger foveal avascular zone (FAZ) area, perimeter, poorer circularity, higher large-vessel perfusion density (PD) and vessel density (VD), and lower whole-vessel VD.
Adding FAZ perimeter and large-vessel VD improved DR progression prediction accuracy (AUC from 0.709 to 0.822).
For VA loss, higher superficial large-vessel PD and lower capillary PD were significant predictors (AUC improved from 0.602 to 0.702).

Conclusions:

Enlargement and irregularity of the FAZ, along with increased superficial large-vessel VD, independently predict DR progression.
Incorporating FAZ and large-vessel OCTA parameters significantly enhances prediction models for both DR worsening and vision decline in diabetic patients.