{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:14:06Z","timestamp":1789132446762,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T00:00:00Z","timestamp":1729728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To characterize the regional variations of choroidal vascularity index (CVI) in patients with diabetes mellitus (DM) using ultra-wide-field optical coherence tomography angiography (UWF-OCTA) and identify their correlations with the onset of diabetic retinopathy (DR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross-sectional, monocular-sampling study recruited 141 participants from four age-matched groups: no DM (NDM), no DR with early DM (EDM) and late DM (LDM), and mild\u2013moderate non-proliferative diabetic retinopathy (mNPDR). UWF-OCTA was employed for circular scans centered on the fovea. CVI in the central region (0\u20131\u2009mm) and four quadrants of the concentric rings with different ranges (1\u20133, 3\u20136, 6\u20139, 9\u201312, 12\u201315, 15\u201318\u2009mm) was obtained for analysis together with their demographic and clinical data. The Area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic efficacy for mNPDR and compared using the DeLong test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average CVI was lower in patients with mNPDR compared to other groups across all regions. Although there was no significant difference in DM duration between the LDM and mNPDR groups, a notable variance in CVI was observed, particularly (<jats:italic>p<\/jats:italic>\u2009=\u20090.0004) in the temporal quadrant of the 15\u201318\u2009mm range (T18). CVI in T18 region was negatively correlated with creatinine levels, while positively correlated with body mass index and estimated glomerular filtration rate (<jats:italic>p<\/jats:italic>s\u2009&amp;lt;\u20090.05). The CVI in the T18 region demonstrated superior diagnostic efficacy (AUC\u2009=\u20090.755), and when combined with those in other regions and clinical data, the AUC rose to 0.907, which was significantly better (<jats:italic>p<\/jats:italic>\u2009=\u20090.0280) than using clinical data alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Reduced CVI was observed in the most peripheral region, highly predictive for mNPDR and associated with the declining renal function, thus enhancing the potential of UWF-OCTA to integrate into DM management and promote early DR screening.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1490831","type":"journal-article","created":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T04:53:09Z","timestamp":1729745589000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Regional assessment of choroidal vascularity index in patients with pre- and early-stage diabetic retinopathy using ultra-wide-field OCTA"],"prefix":"10.3389","volume":"11","author":[{"given":"Yulei","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoxiong","family":"Xian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minghui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuqing","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaolin","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1111\/ceo.14269","article-title":"Diabetic retinopathy in China: epidemiology, screening and treatment trends-a review","volume":"51","author":"Li","year":"2023","journal-title":"Clin Experiment Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1016\/j.ophtha.2021.04.027","article-title":"Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis","volume":"128","author":"Teo","year":"2021","journal-title":"Ophthalmology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4296","DOI":"10.1038\/s41467-023-39864-w","article-title":"Prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy in adults with diabetes in China","volume":"14","author":"Hou","year":"2023","journal-title":"Nat Commun"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"370","DOI":"10.3389\/fendo.2020.00370","article-title":"Vascular complication in adolescents with diabetes mellitus","volume":"11","author":"Graves","year":"2020","journal-title":"Front Endocrinol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"10167","DOI":"10.3390\/ijms241210167","article-title":"The role of diabetic choroidopathy in the pathogenesis and progression of diabetic retinopathy","volume":"24","author":"Scuderi","year":"2023","journal-title":"Int J Mol Sci"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"100994","DOI":"10.1016\/j.preteyeres.2021.100994","article-title":"Exploring the choroidal vascular labyrinth and its molecular and structural roles in health and disease","volume":"87","author":"Brinks","year":"2022","journal-title":"Prog Retin Eye Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.visres.2017.04.011","article-title":"Diabetic choroidopathy","volume":"139","author":"Lutty","year":"2017","journal-title":"Vis Res"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1007\/s00417-016-3360-8","article-title":"Diabetic choroidopathy: a review of the current literature","volume":"254","author":"Melancia","year":"2016","journal-title":"Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol"},{"key":"ref9","first-page":"413","article-title":"Choeroidal vasculopathy detected by indocyanine green angiography in diabetic patients","volume":"109","author":"Jankowska-Lech","year":"2007","journal-title":"Klin Ocz"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"326","DOI":"10.3390\/diagnostics14030326","article-title":"Optical coherence tomography angiography as a diagnostic tool for diabetic retinopathy","volume":"14","author":"Wijesingha","year":"2024","journal-title":"Diagn Basel Switz"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1079217","DOI":"10.3389\/fendo.2022.1079217","article-title":"Classification of diabetic retinopathy: past, present and future","volume":"13","author":"Yang","year":"2022","journal-title":"Front Endocrinol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1136\/bjophthalmol-2021-318782","article-title":"Choroidal vascularity index: a step towards software as a medical device","volume":"106","author":"Betzler","year":"2022","journal-title":"Br J Ophthalmol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"595","DOI":"10.3390\/jcm9020595","article-title":"Choroidal vascularity index: an in-depth analysis of this novel optical coherence tomography parameter","volume":"9","author":"Iovino","year":"2020","journal-title":"J Clin Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"100829","DOI":"10.1016\/j.preteyeres.2020.100829","article-title":"Exploring choroidal angioarchitecture in health and disease using choroidal vascularity index","volume":"77","author":"Agrawal","year":"2020","journal-title":"Prog Retin Eye Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3882","DOI":"10.3390\/jcm11133882","article-title":"Correlation between choroidal vascularity index and outer retina in patients with diabetic retinopathy","volume":"11","author":"Sidorczuk","year":"2022","journal-title":"J Clin Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.ajo.2017.09.030","article-title":"Diabetic choroidopathy: choroidal vascular density and volume in diabetic retinopathy with swept-source optical coherence tomography","volume":"184","author":"Wang","year":"2017","journal-title":"Am J Ophthalmol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1007\/s40618-023-02236-8","article-title":"Choroidal vascularity index as a predictor for the development of retinopathy in diabetic patients","volume":"47","author":"Keskin","year":"2024","journal-title":"J Endocrinol Investig"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s40942-021-00355-z","article-title":"Choroidal changes and associations with visual acuity in diabetic patients","volume":"8","author":"Marques","year":"2022","journal-title":"Int J Retina Vitr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"916323","DOI":"10.3389\/fphys.2022.916323","article-title":"Compartmental analysis of three-dimensional choroidal vascularity and thickness of myopic eyes in young adults using SS-OCTA","volume":"13","author":"Luo","year":"2022","journal-title":"Front Physiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1184717","DOI":"10.3389\/fendo.2023.1184717","article-title":"Analysis of retinal and choroidal characteristics in patients with early diabetic retinopathy using WSS-OCTA","volume":"14","author":"Qi","year":"2023","journal-title":"Front Endocrinol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1036625","DOI":"10.3389\/fendo.2022.1036625","article-title":"Assessment of choroidal structural changes in patients with pre- and early-stage clinical diabetic retinopathy using wide-field SS-OCTA","volume":"13","author":"Xu","year":"2022","journal-title":"Front Endocrinol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1080\/17434440.2021.1902301","article-title":"Recent advances in wide field and ultrawide field optical coherence tomography angiography in retinochoroidal pathologies","volume":"18","author":"Kalra","year":"2021","journal-title":"Expert Rev Med Devices"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1109\/TMI.2022.3222638","article-title":"Ultra-widefield OCT angiography","volume":"42","author":"Niederleithner","year":"2023","journal-title":"IEEE Trans Med Imaging"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1194320","DOI":"10.3389\/fpubh.2023.1194320","article-title":"Central and peripheral changes in the retina and choroid in patients with diabetes mellitus without clinical diabetic retinopathy assessed by ultra-wide-field optical coherence tomography angiography","volume":"11","author":"Zhao","year":"2023","journal-title":"Front Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.ajo.2024.02.016","article-title":"Ultra-wide-field optical coherence tomography and Gaussian curvature to assess macular and paravascular retinoschisis in high myopia","volume":"263","author":"Zhao","year":"2024","journal-title":"Am J Ophthalmol"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2024.06.017","article-title":"Myopic staphyloma assessment by OCT angiography","author":"Rispoli","year":"2024","journal-title":"Ophthalmology"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/978-0-387-98144-4_7","article-title":"Generation of random numbers","volume-title":"Computational statistics","author":"Gentle","year":"2009"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.2337\/dc24-S002","article-title":"2. Diagnosis and classification of diabetes: standards of care in diabetes-2024","volume":"47","year":"2024","journal-title":"Diabetes Care"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.1016\/S0161-6420(03)00475-5","article-title":"Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales","volume":"110","author":"Wilkinson","year":"2003","journal-title":"Ophthalmology"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.3390\/jcm12051911","article-title":"Quantitative assessment of choroidal thickness and choroidal vascular features in healthy eyes based on image binarization of EDI-OCT: a single-center cross-sectional analysis in Chinese population","volume":"12","author":"Wang","year":"2023","journal-title":"J Clin Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1490831\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T04:53:11Z","timestamp":1729745591000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1490831\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,24]]},"references-count":30,"alternative-id":["10.3389\/fmed.2024.1490831"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1490831","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,24]]},"article-number":"1490831"}}