Acta Diabetologica

, Volume 55, Issue 10, pp 1075–1082 | Cite as

Optical coherence tomography angiography findings of neurovascular changes in type 2 diabetes mellitus patients without clinical diabetic retinopathy

  • Zijing Li
  • Mohammad Alzogool
  • Jianhui Xiao
  • Si Zhang
  • Peng Zeng
  • Yuqing Lan
Original Article



To evaluate the effect of early screening with OCTA in type 2 diabetes mellitus (T2DM) patients without clinical DR (NDR).


This was a cross-sectional case–control clinical study. Eighty-four eyes of 84 patients (44 T2DM and 40 control subjects) were included. Images were obtained using AngioVue software 2.0 of the OCTA device. Foveal avascular zone (FAZ) area, FAZ perimeter (PERIM), choriocapillary flow area (CCF), acircularity index (AI), foveal vessel density in a 300-µm-wide region around FAZ (FD), macular-associated vessel density (VD) and optic disc-associated capillary density (CD) were compared between the T2DM and control groups. In the T2DM group, the correlations between the above parameters and best-corrected visual acuity (BCVA) were assessed.


Enlarged FAZ, increased PERIM, reduced CCF, reduced parafoveal VD and decreased CD inside the disc were significantly more obvious in the NDR subjects than in the control subjects (FAZ 0.43 ± 0.13 versus 0.37 ± 0.08 mm2, p = 0.02; PERIM 2.60 ± 0.45 versus 2.41 ± 0.28 mm, p = 0.04; CCF 1.94 ± 0.28 versus 2.05 ± 0.11 mm2, p = 0.02; superficial parafoveal VD 48.01 ± 3.41 versus 50.74 ± 3.67%, p = 0.003; deep parafoveal VD 51.60 ± 3.52 versus 54.45 ± 4.19%, p = 0.004; CD inside disc 49.75 ± 4.84 versus 53.19 ± 4.04%, p = 0.003). In the NDR subjects, logMAR BCVA (β = − 0.55, p < 0.01) and FAZ (r = − 0.62, p < 0.01) showed a significant negative correlation with superficial total VD, respectively.


Preclinical DR can be detected by OCTA. Parameters such as FAZ, PERIM, CCF, VD and CD may be useful for early detection of microvascular impairments in DM patients with NDR. Superficial VD and FAZ are possible sensitive visual acuity predictors in NDR subjects. OCTA may be a promising non-invasive tool in daily DR screening.


Optical coherence tomography angiography Diabetic retinopathy Neurovascular changes Early screening 



The research was funded by the National Natural Science Foundation of China 81570845 and the Natural Science Foundation of Guangdong Province 2015A030313019. The authors wish to acknowledge Dr. David Huang, Ph.D., Casey Eye Institute, Oregon Health and Science University, who gave an excellent speech in Portland and inspired our research.


National Natural Science Foundation of China 81570845; Natural Science Foundation of Guangdong Province 2015A030313019.

Compliance with ethical standards

Conflict of interest

No conflicting relationship exists for any author.

Statement of human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Statement of informed consent

Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Zijing Li
    • 1
  • Mohammad Alzogool
    • 1
  • Jianhui Xiao
    • 1
  • Si Zhang
    • 1
  • Peng Zeng
    • 1
  • Yuqing Lan
    • 1
  1. 1.Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouPeople’s Republic of China

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