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Assessing Retinal Non-Perfusion With Ultra-Widefield OCT-A: Correlations With Diabetic Retinopathy Severity and
Selin S Gumustop1, Xinyi Ding1, Yi Stephanie Zhang2
1From the Harvard Retinal Imaging Lab (S.S.G., X.D., I.P., Y.Z., L.W., F.R., I.G., C.C., K.N.N., S.H.S., S.L.W., J.B.M.), Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
American Journal of Ophthalmology
|April 12, 2026
Summary
Ultra-widefield optical coherence tomography angiography (UWF-OCTA) effectively detects ischemia in diabetic retinopathy (DR). Larger scan areas better assess peripheral lesions, aiding DR progression monitoring.
Area of Science:
- Ophthalmology
- Medical Imaging
- Diabetic Retinopathy Research
Background:
- Diabetic retinopathy (DR) is a leading cause of vision loss.
- Assessing peripheral retinal changes is crucial for DR management.
- Ultra-widefield optical coherence tomography angiography (UWF-OCTA) offers detailed visualization of retinal vasculature.
Purpose of the Study:
- To compare non-perfusion area (NPA) and ischemic index (ISI) between 12x12-mm and 21x26-mm UWF-OCTA scans.
- To evaluate the correlation of NPA and ISI with DR severity.
- To assess the association of NPA and ISI with predominantly peripheral lesions (PPLs).
Main Methods:
- Retrospective analysis of 101 eyes with DR using UWF-OCTA.
- Calculation of NPA and ISI using a semi-automatic algorithm.
- Correlation analysis with DR severity and PPLs identified via ultra-widefield color fundus photography.
Main Results:
- Both 12x12-mm and 21x26-mm UWF-OCTA scans showed significantly higher NPA/ISI in proliferative DR (PDR) versus non-proliferative DR (NPDR).
- ISI from both scan sizes correlated significantly with DR severity.
- The 21x26-mm scan demonstrated a significant association with the presence and extent of PPLs.
Conclusions:
- NPA/ISI derived from UWF-OCTA are significant predictors of DR severity.
- The 21x26-mm UWF-OCTA scan is superior in evaluating peripheral ischemia and PPLs.
- Wider field UWF-OCTA imaging is valuable for monitoring DR progression.
