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Participants were aged \u226540 years (mean age 57.3 years, SD 10.3), and 410 (60.7%) were male.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>The primary outcome was all-cause mortality. Quantitative retinal markers were derived from fundus photographs and optical coherence tomography using AutoMorph and Topcon Advanced Boundary Segmentation, respectively. We used unadjusted and adjusted Cox-proportional hazards models to estimate hazard ratios (HR) for the association between retinal features and time to death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After adjusting for sociodemographic factors, each 1-SD decrease in arterial fractal dimension (HR: 1.54, 95%\u2009CI: 1.18 to 2.04), arterial vessel density (HR: 1.59, 95%\u2009CI: 1.15 to 2.17), arterial average width (HR: 1.35, 95%\u2009CI: 1.02 to 1.79), central retinal arteriolar equivalent (HR: 1.39, 95%\u2009CI: 1.05 to 1.82) and ganglion cell-inner plexiform layer (GC-IPL) thickness (HR: 1.61, 95%\u2009CI: 1.03 to 2.50) was associated with increased mortality risk. When also adjusting for hypertension, arterial fractal dimension (HR: 1.45, 95%\u2009CI: 1.08 to 1.92), arterial vessel density (HR: 1.47, 95%\u2009CI: 1.05 to 2.08) and GC-IPL thickness (HR: 1.56, 95%\u2009CI: 1.03 to 2.38) remained significantly associated with mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Several quantitative retinal markers, relating to both microvascular morphology and retinal neural thickness, are associated with increased mortality among individuals with PDR. The role of retinal imaging in identifying those individuals with PDR most at risk of imminent life-threatening sequelae warrants further investigation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105231","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:10:49Z","timestamp":1757481049000},"page":"e105231","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative retinal morphology and mortality in individuals with proliferative diabetic retinopathy: a retrospective cohort study in a large real-world population"],"prefix":"10.1136","volume":"15","author":[{"given":"Abdullah Zafar","family":"Khan","sequence":"first","affiliation":[{"name":"University College London, London, UK"},{"name":"University College Dublin School of Medicine, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5570-5794","authenticated-orcid":false,"given":"Ana Paula","family":"Ribeiro Reis","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham","family":"Olvera-Barrios","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukun","family":"Zhou","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic J","family":"Williamson","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robbert R","family":"Struyyen","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hagar","family":"Khalid","sequence":"additional","affiliation":[{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Egan","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alastair K","family":"Denniston","sequence":"additional","affiliation":[{"name":"NIHR Birmingham Biomedical Research Centre, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pearse A","family":"Keane","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4915-4353","authenticated-orcid":false,"given":"Siegfried K","family":"Wagner","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"2025090922103831000_15.9.e105231.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-71908-9"},{"key":"2025090922103831000_15.9.e105231.2","unstructured":"International Diabetes Federation . 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