Surface subsidence induced by underground coal mining is a primary driver of ecological degradation. The traditional Remote Sensing Ecological Index (RSEI), however, struggles to capture surface deformation constraints and vegetation response lags. To address this, we developed a Mining Deformation–Ecology Coupling Index (MDECI). This index integrates Interferometric Synthetic Aperture Radar (InSAR)-monitored surface stability with multi-spectral indicators via Principal Component Analysis (PCA). We applied this method to the Datong Coalfield, China, using 231 Sentinel-1A SAR scenes and 8 Landsat images (2017–2024) to validate the effectiveness of the index. Meanwhile, we systematically analyzed non-linear response mechanisms, the Ecological Turning Point (ETP), and spatial clustering characteristics. The results demonstrate the following: (1) InSAR and MDECI effectively identified patterns of surface subsidence and ecological decline. Subsidence centers expanded to a maximum of −2085 mm, causing the mean MDECI in these areas to drop to 0.185 (<−1800 mm). This represents a 57.4% decrease relative to the regional average (0.434). (2) MDECI outperformed traditional models with a stable Average Correlation Coefficient (ACC) (0.63–0.75) and high cross-correlation coefficients with RSEI (0.906) and the Mine-specific Eco-environment Index (MSEEI) (0.931). During the 2018 drought, MDECI maintained a robust ACC of 0.628 while RSEI dropped to 0.482. (3) Multi-scale analysis revealed a unimodal MDECI response with an ETP at −100 mm. Initial ‘micro-disturbance gain’ (0.371 to 0.471) is followed by a progressive decline to a minimum of 0.185 under severe deformation. (4) Local Indicators of Spatial Association (LISA) spatial clustering characterized the distribution patterns of ecological damage and localised high-maintenance areas. High–Low damaged areas accounted for 5.09%, while High–High high-maintenance areas reached 9.00%. The scale of High–High areas was approximately 1.77 times that of the damaged areas. The MDECI addresses the deficiencies of traditional indices in high-disturbance areas and isolates the impact of mining on the ecology, providing a quantitative basis for risk identification and differentiated restoration.