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We aim to describe the main features of ischemic areas that can be identified through fundoscopy, color fundus photography, optical coherence tomography (OCT), and OCT angiography and provide clinicians with a step\u2010by\u2010step approach to identifying prognostically unfavorable markers of DR and accurately staging DR to improve management and prevent severe proliferative DR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Reports<\/jats:title>\n                    <jats:p>Cases of DR with subtle but significant retinal findings that are not readily identifiable unless a systematic multimodal imaging approach is used. We emphasize the presence of retinal ischemia in each case and show how to identify retinal vascular nonperfusion and its complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Advanced stages of DR may lack prominent fundus findings and may be easily misdiagnosed as milder DR without a comprehensive multimodal imaging diagnostic approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ovs2.70090","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:01:47Z","timestamp":1785387707000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case series: The role of retinal ischemia in the pathogenesis and clinical manifestation of diabetic 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