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Choriocapillaris flow deficit and the risk of referable diabetic retinopathy: a longitudinal SS-OCTA study
  1. Wei Wang1,
  2. Weijing Cheng1,
  3. Shaopeng Yang1,
  4. Yifan Chen2,
  5. Zhuoting Zhu3,
  6. Wenyong Huang1
  1. 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People's Republic of China
  2. 2 John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3 Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
  1. Correspondence to Dr Wenyong Huang, Sun Yat-Sen University, Guangzhou, China; huangwenyong{at}


Aims To investigate the association between the choriocapillaris flow deficit percentage (CC FD%) and the 1-year incidence of referable diabetic retinopathy (RDR) in participants with type 2 diabetes mellitus (DM).

Methods This prospective cohort study included participants with type 2 DM. The DR status was graded based on the ETDRS-7 photography. The CC FD% in the central 1 mm area, inner circle (1.5 mm to 2.5 mm), outer circle (2.5 mm to 5.0 mm) and the entire area in the macular region were measured using swept-source optical coherence tomography angiography (SS-OCTA). Logistic regression analysis was used to examine the association between baseline CC FD% and 1-year incident RDR.

Results A total of 1222 patients (1222 eyes, mean age: 65.1±7.4 years) with complete baseline and 1-year follow-up data were included. Each 1% increase in baseline CC FD% was significantly associated with a 1.69 times (relative risk 2.69; 95% CI 1.53 to 4.71; p=0.001) higher odds for development of RDR after 1-year follow-up, after adjusting for other confounding factors.

Conclusions A greater baseline CC FD% detected by SS-OCTA reliably predicted higher risks of RDR in participants with type 2 DM. Thus, CC FD% may act as a novel biomarker for predicting the onset and progression of DR.

  • Anatomy
  • Choroid
  • Diagnostic tests/Investigation
  • Epidemiology
  • Imaging

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • WW, WC and SY are joint first authors.

  • WW, WC and SY contributed equally.

  • Correction notice This article has been amended since it was first published. WW, WC and SY are joint first authors.

  • Contributors Study concept and design: WW, ZZ; acquisition, analyses or interpretation: all authors; drafting of the manuscript: WW, SY, YC; critical revision of the manuscript for important intellectual content: all authors; statistical analyses: WW; obtained funding: WW, ZZ, WH; administrative, technical or material support: all authors; study supervision: WH; study guarantor: WH.

  • Funding This research was supported by the National Natural Science Foundation of China (82000901, 8217084), Science and Technology Planning Project of Guangdong Province (202102010162), Fundamental Research Funds of the State Key Laboratory of Ophthalmology (303060202400362).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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