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Associations of quantitative contrast sensitivity with vascular metrics on widefield swept-source OCT angiography across stages of diabetic retinopathy
  1. Filippos Vingopoulos1,2,
  2. Grace Baldwin2,
  3. Raviv Katz2,
  4. Ying Cui2,3,
  5. Jade Y Moon2,
  6. Itika Garg2,
  7. Rebecca Zeng2,
  8. Nimesh A Patel1,
  9. David Wu1,
  10. Deeba Husain1,
  11. Joan W Miller1,
  12. Leo A Kim1,
  13. Demetrios G Vavvas1,
  14. John B Miller1,2
  1. 1Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
  2. 2Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
  3. 3Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangzhou, China
  1. Correspondence to Dr John B Miller, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA; john_miller{at}


Purpose To investigate structure–function associations between contrast sensitivity (CS) and widefield swept-source optical coherence tomography angiography (WF SS-OCTA) vascular metrics across stages of non-proliferative (NPDR) and proliferative diabetic retinopathy (PDR), without diabetic macular oedema.

Methods Prospective cross-sectional study in 140 eyes of 99 patients: 33 mild NPDR, 24 moderate/severe NPDR, 15 PDR, 33 diabetic without DR (DMnoDR) and 46 control eyes. Mixed-effects multivariable regression models to evaluate associations between quantitative contrast sensitivity function (Adaptive Sensory Technology) and vessel density (VD) and vessel skeletonised density (VSD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) on same-day imaging with WF SS-OCTA (Plex Elite 9000, Carl Zeiss Meditec).

Results Standardised β coefficients for area under the logarithm of contrast sensitivity function curve (AULCSF) versus visual acuity (VA) at 3×3 mm scans: SCP VSD (β=0.32, p<0.001 vs −0.18, p=0.044), DCP VSD (β=0.30, p<0.001 vs −0.21, p=0.02), SCP VD (β=0.25, p=0.004 vs −0.13, p=0.129), DCP VD (β=0.26, p=0.003 vs −0.19, p=0.034). AULCSF was significantly reduced in mild NPDR (β=−0.28, p<0.001) and DMnoDR (β=−0.19, p=0.005) versus controls, while VA was not significantly different. AULCSF performed better than VA in differentiating between controls and DMnoDR (0.69 vs 0.50), controls and mild NPDR (0.76 vs 0.61) and controls and moderate/severe NPDR (0.89 vs 0.73).

Conclusions DR-induced microvascular changes on OCTA are associated with larger changes on CS than in VA. CS is affected earlier than VA in the course of DR and performed better in discriminating between controls, DMnoDR and across DR stages.

  • Imaging
  • Retina
  • Vision

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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  • Presented at Presented in part at the Macula Society 2023, Miami, Florida, USA and at the Association for Research in Vision and Ophthalmology (ARVO) 2022, Denver, Colorado, USA.

  • Contributors Concept and design—FV, NAP, DW, DH, JWM, LK, DV and JBM. Data collection—FV, GB, RK, YC, JYM, IG and RZ. Data analysis—FV and GB. Data interpretation—FV, GB and JBM. Drafting original manuscript—FV. Critically revising manuscript—GB, RK, YC, JYM, IG, RZ, NAP, DW, DH, JWM, LK, DV and JBM. Data guarantors—FV, GB and JBM.

  • Funding Lions International Fund (grant 530125 and 530869).

  • Disclaimer The funding organisation had no role in design or conduct of this research.

  • Competing interests No conflicting relationship exists for any author. FV, GB, RK, YC, IG, JYM and RZ—no disclosures. NAP is a consultant for Atheneum, Alcon, Allergan, Alimera, Eyepoint, Lifesciences, Guidepoint and GLG. DW holds a patent through Massachusetts Eye and Ear. DH is a consultant for Allergan, Genentech and Omeicos Therapeutics, and has received financial support from the National Eye Institute, Lions VisionGift, Commonwealth Grant, Lions International, Syneos and the Macular Society. JWM is a consultant for Heidelberg Engineering, Sunovion, KalVista Pharmaceuticals and ONL Therapeutics; holds a patent through and has received financial support from ONL, Valeant Pharmaceuticals/Massachusetts Eye and Ear; and has received financial support from Lowy Medical Research Institute. LK has received research support from the National Eye Institute and CureVac; and has a financial arrangement with Pykus Therapeutics. DV is a consultant for Valitor and Olix Pharmaceuticals; is a consultant for Valitor and Olix Pharmaceuticals; and has received financial support from the National Eye Institute and by grants from the National Institute of Health (R01EY025362 and R21EY0203079), Research to Prevent Blindness, Loefflers Family Foundation, Yeatts Family Foundation and Alcon Research Institute. JBM is a consultant for Alcon, Allergan, Carl Zeiss, Sunovion and Genentech.

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