{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T18:05:53Z","timestamp":1780596353721,"version":"3.54.1"},"reference-count":34,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"NIHR Moorfields Biomedical Research Centre and Clinical Research Facility","award":["SIVS1068"],"award-info":[{"award-number":["SIVS1068"]}]},{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","award":["749092"],"award-info":[{"award-number":["749092"]}],"id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,5,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/aims<\/jats:title>\n                    <jats:p>To characterise the distribution of retinal non-perfusion and its relationship with neovascularisation elsewhere (NVE) and visual acuity (VA) in referable diabetic retinopathy (DR) using ultra-widefield fluorescein angiography (UWFA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eyes with treatment-na\u00efve moderately severe non-proliferative DR (NPDR) to proliferative diabetic retinopathy (PDR) (Diabetic Retinopathy Severity Scale (DRSS) level 43\u201360) with available UWFA were included in this study. Total and zonal non-perfusion and NVE area were manually delineated across concentric zones (central 1\u201310\u2009mm, extended posterior &gt;10\u201320\u2009mm and mid-peripheral &gt;20\u201330\u2009mm diameter). The Non-Perfusion Index (NPI) was calculated as the ratio of non-perfused area to total area per zone. Associations between NPI, NVE, DR severity and best-recorded VA (BRVA) were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 133 eyes (60.9% NPDR, 39.1% PDR) were analysed. The highest NPI occurred in the mid-periphery (20\u201330\u2009mm) and posterior pole (15\u201320\u2009mm) zones, with nasal preponderance. NVE was most frequently observed in the posterior pole (66%) and nasal quadrants. Central and mid-peripheral NPI correlated with NVE area in corresponding zones, showing quadrant-specific associations. Receiver operating characteristic analysis identified a total NPI threshold of 0.23 to differentiate PDR from NPDR (area under the curve=0.798), with the lowest threshold in the superior quadrant. Neither NPI nor NVE area correlated with BRVA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>NVE represents a localised response to adjacent ischaemia predominantly affecting the nasal and extended posterior retina. NPI threshold of 0.23 distinguishes proliferative from non-proliferative stages, with the superior quadrant showing greater susceptibility to NVE at lower ischaemic levels. No significant correlation found between NPI, NVE area and visual acuity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-329361","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T17:20:18Z","timestamp":1780593618000},"page":"bjo-2025-329361","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Quantification of retinal non-perfusion in eyes with diabetic retinopathy to study the association with retinal neovascularisation: INSPIRED study report 3"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5311-4015","authenticated-orcid":false,"given":"Hagar","family":"Khalid","sequence":"first","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"},{"name":"Tanta University Faculty of Medicine, Tanta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5945-9316","authenticated-orcid":false,"given":"Wei-Shan","family":"Tsai","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"},{"name":"Hampshire Hospitals NHS Foundation Trust, Winchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7956-6056","authenticated-orcid":false,"given":"Francesca","family":"Lamanna","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Riotto","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarega","family":"Gurudas","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Roch","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sobha","family":"Sivaprasad","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"2026060410201251000_bjo-2025-329361v1.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199412013312203"},{"key":"2026060410201251000_bjo-2025-329361v1.2","doi-asserted-by":"crossref","unstructured":"Scott I , Flynn H , Smiddy W . 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