Aims. To quantify the capillary density of the optic nerve head in healthy control eyes and different stages of diabetic retinopathy (DR) eyes and identify the parameters to detect eyes with or without DR using optical coherence tomographic angiography (OCTA). Methods. In this cross-sectional study, 211 eyes of 121 participants with type 2 diabetes with different stages of DR or without DR and 73 eyes of 38 healthy age-matched controls were imaged by OCTA. Radial peripapillary capillary (RPC) plexus density and retinal nerve fiber layer (RNFL) thickness were examined. The mixed model binary logistic regression model was used to identify the parameters to detect eyes with or without DR. The area under the receiver operating characteristic (ROC) curve was calculated. Results. RPC density decreased significantly in diabetic patients without DR compared with the healthy controls, and it was negatively correlated with the severity of DR (P<0.01). RPC density was a significant parameter to distinguish diabetic eyes with or without DR (P<0.01). The area under the ROC curve was 0.743. Conclusions. Quantification of RPC density by OCTA provides evidence of microvascular changes in the optic nerve in diabetic patients. RPC density can serve as a possible biomarker in detecting eyes with DR. Larger cohort studies need to support this statement.

Aims . To compare the relationship between the nonperfusion area (NPA) on ultra‐widefield fluorescein angiography (UWFFA) and the nonflow area (NFA) on optical coherence tomographic angiography (OCTA) in retinal vein occlusion (RVO). Methods . Cross‐sectional study. 46 eyes of 46 RVO patients who underwent UWFFA and OCTA. NPA and ischemic index (ISI) were quantified on UWWFA. NFA, vessel density (VD) of the superficial capillary plexus (SCP), the deep capillary plexus (DCP), and the size foveal avascular zone (FAZ) on 3 ∗ 3 mm OCTA were measured. The association of the NPA and ISI on UWWFA and the parameters on OCTA were analyzed. Spearman correlation was used for statistical testing. Results . The NPA and ISI on UWFFA were significantly correlated with the NFA on OCTA in RVO, and r values were 0.688 ( p < 0.01) and 0.680 ( p < 0.01), respectively. VD in the SCP of the temporal quadrant was negatively correlated with NPA and ISI, and r values were −0.346 ( p < 0.05) and −0.337 ( p < 0.05), respectively. VD in the DCP of the temporal quadrant was negatively correlated with the NPA, and the r value was −0.246 ( p < 0.05). No significant correlation was found between the NPA and ISI on UWFFA and VD of other quadrants in the SCP or DCP and the FAZ area on OCTA. Conclusion . NPA in the peripheral retina was correlated with NFA in macula. NFA detected by OCTA could be an indicator of the ischemic status in RVO.

Objectives: To investigate the spatial distribution pattern of cuticular drusen using en face OCT and determine its relationship with 2-year progression of age-related macular degeneration (AMD). Methods: This study included 87 eyes from 57 participants with intermediate AMD and cuticular drusen enroled in the Amish Eye Study who completed two years of follow-up. Multimodal imaging, including volume spectral-domain OCT, was performed. Density of cuticular drusen was quantified on en face OCT across three Early Treatment Diabetic Retinopathy Study (ETDRS) grid zones using ImageJ. K-means clustering analysis was used to categorize distribution patterns. Firth’s penalized logistic regression evaluated association between cuticular drusen distribution categories and progression to late AMD at 2 years. Results: Three spatial phenotypes of cuticular drusen were identified: central-dominant (57.5%), outer-macular-dominant (32.2%), and diffuse (10.3%). Over two years, five eyes progressed to late AMD, four of which belonged to the outer-macular-dominant group. In unadjusted Firth regression, the outer-macular-dominant phenotype was associated with higher odds of progression than the other phenotypes (OR 7.16; 95% CI 1.24–74.20, p = 0.027). After adjustment for subretinal drusenoid deposits (SDDs) and large drusen, the association between spatial phenotype and progression remained (OR 11.53; 95% CI 1.62–169.00; p = 0.013), while SDDs were also associated with progression (OR 9.26; 95% CI 1.36–78.65; p = 0.023). Conclusions: Clustering of en face OCT–derived spatial features identified distinct cuticular drusen phenotypes within the macula. The outer-macular-dominant phenotype may be associated with an increased likelihood of AMD progression in this exploratory analysis.

Objectives To investigate the spatial distribution pattern of cuticular drusen using en face OCT and determine its relationship with 2-year progression of age-related macular degeneration (AMD). Methods This study included 87 eyes from 57 participants with intermediate AMD and cuticular drusen enrolled in the Amish Eye Study who completed two years of follow-up. Multimodal imaging, including volume spectral-domain OCT, was performed. Density of cuticular drusen was quantified on en face OCT across three Early Treatment Diabetic Retinopathy Study (ETDRS) grid zones using ImageJ. K-means clustering analysis was used to categorize distribution patterns. Firth’s penalized logistic regression evaluated association between cuticular drusen distribution categories and progression to late AMD at 2 years. Results Cuticular drusen exhibited a concentric pattern within 6x6mm macular area. Mean (SD) density was highest in central zone (6.14 (3.89) count/mm2). Cluster analysis classified eyes into predominantly central (57.5%), predominantly peripheral (32.2%), and diffuse (10.3%) categories. Over 2 years, 5 eyes progressed to late AMD, 4 of which belonged to predominantly peripheral group. Firth logistic regression demonstrated that predominantly peripheral category had significantly increased risk of AMD progression compared to low-risk groups (predominantly central and diffuse), with an odds ratio of 7.2 (95% CI: 1.2–74.2, p = 0.027). Conclusions The spatial distribution of cuticular drusen exhibits a concentric, centrally-weighted pattern. A predominantly peripheral distribution of cuticular drusen is significantly associated with progression to late AMD over two years. This quantifiable distribution pattern may serve as a novel high-risk biomarker for advanced AMD.