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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
Published on: February 18, 2022
Using OCT Angiography to Predict Diabetic Retinopathy Progression and Vision Decline in a Multiethnic Cohort
Qianhui Yang1,2, Kelvin Y C Teo2,3,4, 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.
Purpose:
To determine whether baseline retinal and choriocapillaris (CC) vascular features measured by OCT angiography (OCTA) can predict diabetic retinopathy (DR) progression or visual acuity (VA) decline in a multiethnic longitudinal cohort.
Design:
Prospective longitudinal cohort study.
Subjects:
A total of 309 eyes from 192 patients with type 2 diabetes mellitus were recruited from a tertiary eye center in Singapore.
Methods:
All participants underwent 3 × 3 mm swept-source OCTA imaging at baseline. Quantitative vascular parameters-including vessel density (VD), perfusion density (PD), and CC flow deficit percentage-were obtained from the superficial and deep retinal layers and from the CC. Larger retinal arterioles and venules were analyzed separately from capillary networks. Diabetic retinopathy progression was defined as a ≥2-step increase on the ETDRS severity scale over 2 years, while VA decline was defined as >1-line reduction in best-corrected VA. Logistic regression and area under the receiver operating characteristic curve (AUC) analyses were used to evaluate predictive performance.
Main Outcome Measures:
Progression of DR and VA decline over 2 years, as predicted by baseline OCTA metrics.
Results:
Over 2 years, 49 eyes (15.9%) demonstrated DR progression. Significant predictors in the superficial layer included larger foveal avascular zone (FAZ) area (odds ratio [OR] = 6.612; P = 0.034), longer perimeter (OR = 1.583; P = 0.002), poorer circularity (OR = 3.23; P = 0.019), higher large-vessel PD (OR = 1.561; P < 0.001) and VD (OR = 2.878; P < 0.001), and lower whole-vessel VD (OR = 0.798; P = 0.010). Adding FAZ perimeter and large-vessel VD improved prediction accuracy (AUC increased from 0.709-0.822). For VA loss, higher superficial large-vessel PD (OR = 1.609; P = 0.002) and lower capillary PD (OR 0.8; P = 0.010) were significant predictors, improving AUC from 0.602 to 0.702.
Conclusions:
Enlargement and irregularity of the FAZ, along with increased superficial large VD, independently predict DR progression. Incorporating FAZ and large-vessel OCTA parameters enhances prediction models for both DR worsening and vision decline in patients with diabetes.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
