The Utility of Optical Coherence Tomography Angiography Biomarkers in Detecting Diabetic Retinopathy

To evaluate associations between optical coherence tomography angiography (OCT-A) metrics and diabetic retinopathy (DR) and compare their discrimination against conventional clinical risk factors.

In this cross-sectional study, 108 adult eyes with diabetes were recruited from tertiary ophthalmology/optometry clinics. DR was clinically graded using ETDRS categories and dichotomised as no DR vs ≥ mild NPDR (primary outcome). Macular 6 × 6 mm OCT-A (Zeiss AngioPlex™) was acquired; scans with signal strength > 7 and without major artefact were included. Quantitative metrics from the superficial capillary plexus included vessel density (VD) and perfusion density (PD) (central/inner/outer/full regions); structural OCT measures and FAZ parameters were secondary. Associations with ≥mild NPDR were assessed using multivariable logistic regression adjusted for age, sex, HbA1c, and diabetes duration. Discrimination was evaluated with ROC curves/AUC (95% CI) and DeLong comparisons of AUCs.

≥Mild DR was present in 63% of eyes. DR was associated with lower VD (central, inner, outer, full) and lower PD (central, inner, full) (all p ≤ 0.04). After adjustment, central VD (OR 0.82, 95% CI 0.68-0.98) and central PD (OR 0.92, 95% CI 0.86-0.99) remained independently associated with DR. The OCT-A model showed moderate discrimination compared to the clinical model (AUC 0.72 vs 0.65); the combined model yielded AUC 0.75.

Central VD and PD from the superficial plexus are independently associated with DR and show moderate discrimination versus conventional clinical factors alone, supporting OCT-A as an adjunctive biomarker for earlier DR detection.