OCT-A May Predict Diabetic Retinopathy, Visual Acuity Progression

Baseline retinal and choriocapillaris OCT angiography (OCT-A) measurements may be able to predict progression of diabetic retinopathy (DR) and visual acuity (VA) decline, according to a recent Singapore study. Increased foveal avascular zone area is an early signal of elevated risk of diabetic retinopathy progression. Photo: Andrew Rixon, OD. Click image to enlarge. Among a cohort of 309 eyes of 192 patients diagnosed with type 2 diabetes, 49 eyes (15.9%) “demonstrated DR progression” and VA decline, with specific factors serving as predictors of DR, such as an increased foveal avascular zone area for DR and “higher superficial large-vessel PD” for VA decline. The authors noted that other factors may have impacted progression, including higher BMI, higher baseline HbA1c levels and a generally shorter axial length than non-progression patients.The researchers described the study’s patient cohort as “multiethnic,” with patients categorized as Chinese, Indian, Malay and others. Study enrollment criteria also required patients to be 21 years of age and older, experiencing type 2 diabetes for a duration of longer than five years, and having “no end-stage renal failure.” Patients were then followed up with for two years after the study’s completion to ensure accuracy and better understand results.While demographic factors were discussed in the paper, the authors concluded that other variables like age, gender, race, DM duration, mean arterial pressure, smoking status and hypertension “didn’t show significant difference between groups.” In addition, the most significant OCT-A predictors of DR progression were located primarily in the superficial capillary plexus; however, after the two-year follow-up, they found that “FAZ parameters in the DCP were associated with DR progression, while the SCP showed no correlation.” The researchers attributed this to “differences in OCT-A metric algorithms and less distinct FAZ boundaries in the deep layer,” as well as changes in FAZ area being difficult to detect due to it being “relatively large even in healthy eyes.”Despite this, the authors concluded that “a larger FAZ area and longer FAZ perimeter in the superficial layer, higher large vessel perfusion, and vessel density, as well as lower capillary vessel perfusion and vessel density, were associated with a higher risk of DR progression over a two-year period,” and that the use of OCTA measurement scans increased the ease with which disease progression could be monitored and predicted.Click here for the journal source. Yang Q, Teo K, Hong Y, et al. Predicting Diabetic Retinopathy Progression and vision decline in a multiethnic cohort with optical coherence tomography angiography, Ophthalmology Science. February 2, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.