{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:25:58Z","timestamp":1791501958920,"version":"4.3.4"},"reference-count":58,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: To investigate the role of multimodal imaging, specifically optical coherence tomography angiography (OCTA) and adaptive optics (AO), in the diagnosis and monitoring of diabetic retinopathy. Methods: Our study represents an observational, cross-sectional analysis including sixty-nine patients from four distinct groups: a control group (17 patients), diabetic patients without diabetic retinopathy (no DR) (14 patients), diabetic patients with non-proliferative diabetic retinopathy (NPDR) (18 patients), and diabetic patients with proliferative diabetic retinopathy (PDR patients). A comprehensive ophthalmological evaluation, along with high-resolution imaging using OCTA and AO, was performed. OCTA images of the superficial capillary plexus, acquired with the OCT Angio Topcon, were analyzed using a custom-developed MATLAB algorithm, while AO retinal vascular images were evaluated with the manufacturer\u2019s software of the Adaptive Optics Retinal Camera rtx1\u2122. Results: Our findings demonstrated statistically significant reductions in foveal avascular zone circularity, superficial capillary plexus density, vessel length density, and fractal dimension, correlating with the severity of diabetic retinopathy, particularly in the PDR. Additionally, mean wall thickness and wall-to-lumen ratio were significantly increased in patients with diabetic retinopathy, notably in PDR. Conclusions: In conclusion, our findings demonstrate that the combined use of OCTA and AO imaging offers complementary insights into the microvascular alterations associated with diabetic retinopathy progression and severity. These high-resolution modalities together reveal both perfusion deficits and structural vascular changes, underscoring their utility as essential tools for early detection, staging, monitoring, and informed management of DR.<\/jats:p>","DOI":"10.3390\/diagnostics15141732","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T07:31:57Z","timestamp":1751959917000},"page":"1732","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Multimodal Imaging of Diabetic Retinopathy: Insights from Optical Coherence Tomography Angiography and Adaptive Optics"],"prefix":"10.3390","volume":"15","author":[{"given":"Andrada-Elena","family":"Mirescu","sequence":"first","affiliation":[{"name":"\u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan George","family":"Deleanu","sequence":"additional","affiliation":[{"name":"\u201cCarol Davila\u201d University of Medicine and Pharmacy, 050747 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanda","family":"Jurja","sequence":"additional","affiliation":[{"name":"\u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"},{"name":"County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4189-6571","authenticated-orcid":false,"given":"Alina","family":"Popa-Cherecheanu","sequence":"additional","affiliation":[{"name":"\u201cCarol Davila\u201d University of Medicine and Pharmacy, 050747 Bucharest, Romania"},{"name":"Department of Ophthalmology, University Emergency Hospital, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Balta","sequence":"additional","affiliation":[{"name":"\u201cCarol Davila\u201d University of Medicine and Pharmacy, 050747 Bucharest, Romania"},{"name":"Clinical Emergency Eye Hospital, 030167 Bucharest, Romania"},{"name":"Retina Clinic, 014142 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Garhofer","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8261-1101","authenticated-orcid":false,"given":"George","family":"Balta","sequence":"additional","affiliation":[{"name":"\u201cCarol Davila\u201d University of Medicine and Pharmacy, 050747 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina-Elena","family":"Cristescu","sequence":"additional","affiliation":[{"name":"Retina Clinic, 014142 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8235-4501","authenticated-orcid":false,"given":"Ioana Teodora","family":"Tofolean","sequence":"additional","affiliation":[{"name":"\u201cCarol Davila\u201d University of Medicine and Pharmacy, 050747 Bucharest, Romania"},{"name":"Clinical Emergency Eye Hospital, 030167 Bucharest, Romania"},{"name":"Retina Clinic, 014142 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16012","DOI":"10.1038\/nrdp.2016.12","article-title":"Diabetic retinopathy","volume":"2","author":"Wong","year":"2016","journal-title":"Nat. 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