Aim To evaluate the association between retinal capillary non-perfusion and diabetic retinopathy (DR) severity using optical coherence tomography-based microangiography (OMAG).

Methods 33 patients (51 eyes) with a history of diabetes underwent imaging with a 68 kHz Cirrus-5000 spectral domain OMAG prototype. Demographic and clinical characteristics were collected. The perfusion index (PI) was defined as per cent coverage of area by retinal vessels with flow, measured within a minimum of 6.8×6.8 mm² OMAG scan. The PI in each ETDRS zone was analysed using an automated algorithm. Univariate and multivariate analyses were used to determine the degree of association between PI and DR severity.

Results 51 eyes with different DR severities were imaged. More severe DR was significantly associated with lower PI after adjusting for logarithm of the minimum angle of resolution best-corrected visual acuity, hyperlipidaemia, diabetes type and ETDRS ring in a multivariate mixed linear model. Compared with the none–mild non-proliferative diabetic retinopathy (NPDR) group, the moderate–severe NPDR group had 2.7 lower PI (p=0.03) and proliferative DR group had 4.3 lower PI (p=0.003). All ETDRS zones except for the foveal centre showed inverse associations between PI and DR severity (p values<0.001 to 0.862).

Conclusions A statistically significant inverse association exists between PI and DR severity. Our study suggests that PI may become a useful biomarker in evaluating and following the progression of DR.