Evaluation of macular microcirculation in prediabetic patients using OCT angiography

To investigate whether subtle vascular pathologies undetectable by fundus examination can be identified in the prediabetic stage using OCTA.

Ege University Hospital, Izmir DESIGN: Retrospective Cohort METHODS: Best corrected visual acuity, intraocular pressure, detailed anterior and posterior segment examinations, OCT angiography (OCTA) were performed on patients diagnosed with prediabetes in the internal medicine department. OCTA was performed using an OptoVue AngioVue XR Avanti SD-OCT (Fremont, USA). Total, foveal, para-perifoveal superficial and deep vasculature; foveal avascular zone (FAZ), outer retina and choriocapillaris were evaluated. Patients with known ocular disease, severe refractive error, best-corrected visual acuity (BCVA) < 0.8 (Snellen), poor OCTA image quality (signal strength ≤ 50), history of ocular surgery or intravitreal injection and systemic diseases other than controlled hypertension or dyslipidemia excluded. Patients without prediabetes (also without any systemic diseases) were included in the study as the control group RESULTS: The mean age was 52.93 ± 11.41 years in the prediabetic group and 50.14 ± 10.71 years in controls, with no significant difference (p = 0.094). Total deep and superficial, foveal deep, perifoveal superficial vascular densities were significantly lower in the prediabetic group (p < 0.05). Prediabetic patients with hypertension showed no change of vascular densities compared with those without hypertension. Those with high total cholesterol had lower choriocapillaris flow (p = 0.01). HbA1c was not correlated with any OCTA parameter CONCLUSION: Patients with prediabetes exhibit subtle but significant reductions in retinal vascular density, particularly within the superficial capillary plexuses when compared with normoglycemic controls. Ophthalmologists and endocrinologists should consider OCTA findings as part of a broader metabolic assessment, particularly for individuals with risk factors such as obesity, dyslipidemia, or family history of diabetes.