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Purpose <p>To evaluate the predictive value of optical coherence tomography angiography (OCTA)-derived parameters for visual acuity (VA) decline in non-proliferative diabetic retinopathy (NPDR).</p> Methods <p>In this retrospective longitudinal study, 102 eyes from 69 patients with NPDR were followed for a median of 30 months. All eyes underwent expanded field 6 × 6-mm and 12 × 12-mm swept-source OCTA centered on the fovea. Quantitative OCTA parameters including ischemia index (ISI), vessel density (VD), and perfusion density (PD) of the superficial (SCP), deep capillary plexus (DCP), and full retina were measured once at baseline. The primary outcomes were ≥ 5-letter and ≥ 10-letter loss in VA from baseline to final follow-up. Multilevel mixed-effects Cox regression models, adjusted for clinical covariates, were used to identify predictors of VA decline. Predictive performance was evaluated using time-dependent receiver operating characteristic (ROC) analysis. Kaplan-Meier survival and Cox regression analyses across ISI-based risk strata further evaluated time-to-visual-decline relationships.</p> Results <p>Baseline ISI was a significant predictor of both ≥ 5-letter (HR: 1.84, 95% CI: 1.25–2.70, <i>p</i> = 0.002) and ≥ 10-letter (HR: 1.89, 95% CI: 1.15–3.10, <i>p</i> = 0.01) VA loss. Other OCTA-derived parameters, including VD and PD in SCP, DCP, and full retina, were not significantly associated with visual outcomes. ISI demonstrated the highest area under the ROC curve for both endpoints (AUC = 0.68), with time-dependent ROC analyses showing improved accuracy over longer follow-up. Kaplan–Meier and ISI-stratified Cox analysis confirmed significantly earlier and more frequent ≥ 5-letter decline in eyes with medium–high baseline ISI.</p> Conclusions <p>ISI is a promising, non-invasive biomarker predictive of visual decline in NPDR, outperforming other OCTA metrics. ISI demonstrated robust and time-increasing discriminative ability and showed a clear dose–response relationship with the risk of vision loss, particularly for ≥ 5-letter decline. These findings highlight the prognostic value of widefield OCTA in NPDR management and support its integration into clinical risk stratification.</p>

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Prognostic value of expanded-field OCT angiography in visual acuity outcomes for non-proliferative diabetic retinopathy

  • 期刊论文

  • 发表日期：

    2026年4月14日

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  • Mauricio D. Garcia,
  • Xinyi Ding,
  • Mridula Shan,
  • Francesco Romano,
  • Jenny Gan,
  • Katherine M. Overbey,
  • Ying Zhu,
  • Ioanna Ploumi,
  • Itika Garg,
  • Filippos Vingopoulos,
  • David M. Wu,
  • Nimesh A. Patel,
  • Leo A. Kim,
  • Deeba Husain,
  • Joan W. Miller,
  • Demetrios G. Vavvas,
  • John B. Miller

摘要

Purpose

To evaluate the predictive value of optical coherence tomography angiography (OCTA)-derived parameters for visual acuity (VA) decline in non-proliferative diabetic retinopathy (NPDR).

Methods

In this retrospective longitudinal study, 102 eyes from 69 patients with NPDR were followed for a median of 30 months. All eyes underwent expanded field 6 × 6-mm and 12 × 12-mm swept-source OCTA centered on the fovea. Quantitative OCTA parameters including ischemia index (ISI), vessel density (VD), and perfusion density (PD) of the superficial (SCP), deep capillary plexus (DCP), and full retina were measured once at baseline. The primary outcomes were ≥ 5-letter and ≥ 10-letter loss in VA from baseline to final follow-up. Multilevel mixed-effects Cox regression models, adjusted for clinical covariates, were used to identify predictors of VA decline. Predictive performance was evaluated using time-dependent receiver operating characteristic (ROC) analysis. Kaplan-Meier survival and Cox regression analyses across ISI-based risk strata further evaluated time-to-visual-decline relationships.

Results

Baseline ISI was a significant predictor of both ≥ 5-letter (HR: 1.84, 95% CI: 1.25–2.70, p = 0.002) and ≥ 10-letter (HR: 1.89, 95% CI: 1.15–3.10, p = 0.01) VA loss. Other OCTA-derived parameters, including VD and PD in SCP, DCP, and full retina, were not significantly associated with visual outcomes. ISI demonstrated the highest area under the ROC curve for both endpoints (AUC = 0.68), with time-dependent ROC analyses showing improved accuracy over longer follow-up. Kaplan–Meier and ISI-stratified Cox analysis confirmed significantly earlier and more frequent ≥ 5-letter decline in eyes with medium–high baseline ISI.

Conclusions

ISI is a promising, non-invasive biomarker predictive of visual decline in NPDR, outperforming other OCTA metrics. ISI demonstrated robust and time-increasing discriminative ability and showed a clear dose–response relationship with the risk of vision loss, particularly for ≥ 5-letter decline. These findings highlight the prognostic value of widefield OCTA in NPDR management and support its integration into clinical risk stratification.