JCNRJournal of Clinical and Nursing Research2208-36852208-3693Bio-Byword Scientific Publishing Pty. Ltd.10.26689/jcnr.v9i7.11593ArticleApplication Study of OCTA-measured Foveal Avascular Zone in Diabetic Retinopathyhttps://artdesignp.com/journal/JCNR/9/7/10.26689/jcnr.v9i7.11593ChenKaihua,PengZhenyu,ShaYonghong2025972025-08-08Changes in the area, perimeter, and circularity index of the foveal avascular zone (FAZ) can be influenced by the filling or occlusion of tiny capillaries surrounding it. In diabetic retinopathy (DR), FAZ-related indicators can provide a quantitative assessment of early DR, predict early disease changes, and offer a theoretical basis for monitoring disease progression and evaluating patients’ visual outcomes. Therefore, finding a simple and noninvasive method to visualize the FAZ has become a research hotspot in ophthalmology. The emergence of optical coherence tomography angiography (OCTA) has filled the technological gap in FAZ measurement. This article reviews the basic principles of OCTA and the clinical application of OCTA-measured FAZ-related indicators in DR, aiming to improve the diagnosis and treatment of DR.

Burton MJ, Ramke J, Marques AP, et al., 2021, The Lancet Global Health Commission on Global Eye Health: Vision Beyond 2020. Lancet Glob Health, 9(4): e489–e551. https://doi.org/10.1016/S2214-109X(20)30488-5.

Saeedi P, Petersohn I, Salpea P, et al., 2019, Global and Regional Diabetes Prevalence Estimates for 2019 and Projections for 2030 and 2045: Results From the International Diabetes Federation Diabetes Atlas, 9th Edition. Diabetes Res Clin Pr, 157: 107843. https://doi.org/10.1016/j.diabres.2019.107843.

Huang Y, Liu J, Meng J, 2021, Bilateral Foveal Hypoplasia With Foveal Capillary. Ophthalmology, 30(02): 84.

Hwang TS, Jia Y, Gao SS, et al., 2015, Optical Coherence Tomography Angiography Features of Diabetic Retinopathy. Retina, 35(11): 2371–2376.

Borrelli E, Parravano M, Sacconi R, et al., 2020, Guidelines on Optical Coherence Tomography Angiography Imaging: 2020 Focused Update. Ophthalmol Ther, 9(4): 697–707.

Bates NM, Tian J, Smiddy WE, et al., 2018, Relationship Between the Morphology of the Foveal Avascular Zone, Retinal Structure, and Macular Circulation in Patients With Diabetes Mellitus. Sci Rep, 8(1): 5355.

Balaratnasingam C, Chae B, Remmer MH, et al., 2015, The Spatial Profile of Macular Pigments Is Related to the Topological Characteristics of the Foveal Avascular Zone. Invest Ophthalmol Vis Sci, 56(13): 7859–7865.

Linderman RE, Muthiah MN, Omoba SB, et al., 2018, Variability of Foveal Avascular Zone Metrics Derived From Optical Coherence Tomography Angiography Images. Transl Vis Sci Technol, 7(5): 20.

He P, Liu C, Yin W, et al., 2019, Research Progress on Blood–Retinal Barrier Damage in Diabetic Retinopathy. Journal of Clinical and Pathological Research, 39(05): 1090–1094.

Fujiwara A, Morizane Y, Hosokawa M, et al., 2017, Factors Affecting Foveal Avascular Zone in Healthy Eyes: An Examination Using Swept-Source Optical Coherence Tomography Angiography. PLoS One, 12(11): e0188572.

Shiihara H, Terasaki H, Sonoda S, et al., 2018, Objective Evaluation of the Size and Shape of the Superficial Foveal Avascular Zone in Normal Subjects by Optical Coherence Tomography Angiography. Sci Rep, 8(1): 10143.

Linderman RE, Muthiah MN, Omoba SB, et al., 2018, Variability of Foveal Avascular Zone Metrics Derived From Optical Coherence Tomography Angiography Images. Transl Vis Sci Technol, 7(5): 20.

Shiihara H, Sakamoto T, Yamashita T, et al., 2017, Reproducibility and Differences in the Area of the Foveal Avascular Zone Measured by Three Different Optical Coherence Tomographic Angiography Instruments. Sci Rep, 7(1): 9853.

Linderman R, Salmon AE, Strampe M, et al., 2017, Assessing the Accuracy of Foveal Avascular Zone Measurements Using Optical Coherence Tomography Angiography: Segmentation and Scaling. Transl Vis Sci Technol, 6(3): 16.

Bates NM, Tian J, Smiddy WE, et al., 2018, Relationship Between the Morphology of the Foveal Avascular Zone, Retinal Structure, and Macular Circulation in Patients With Diabetes Mellitus. Sci Rep, 8(1): 5355.

Takase N, Nozaki M, Kato A, et al., 2015, Enlargement of Foveal Avascular Zone in Diabetic Eyes Evaluated by En Face Optical Coherence Tomography Angiography. Retina, 35: 2377–2383.

Samara WA, Shahlaee A, Adam MK, et al., 2017, Quantification of Diabetic Macular Ischemia Using Optical Coherence Tomography Angiography and Its Relationship With Visual Acuity. Ophthalmology, 124(2): 235–244.

Dimitrova G, Chihara E, Takahashi H, et al., 2017, Quantitative Retinal Optical Coherence Tomography Angiography in Patients With Diabetes Without Diabetic Retinopathy. Invest Ophthalmol Vis Sci, 58(1): 190–196.

Johnson B, 2017, Irregular Foveal Avascular Zone Morphology in Early Diabetic Retinopathy. Investigative Ophthalmology & Visual Science, 58(8): 3456–3462.

Krawitz BD, Mo S, Geyman LS, et al., 2017, Acircularity Index and Axis Ratio of the Foveal Avascular Zone in Diabetic Eyes and Healthy Controls Measured by Optical Coherence Tomography Angiography. Vision Res, 139: 177–186.

Kim K, Kim ES, Yu SY, 2018, Analysis of Foveal Microvascular Changes and Inner Retinal Layer Thinning in Patients With Diabetes Using Optical Coherence Tomography Angiography. British Journal of Ophthalmology, 102(9): 1226–1231.

Rodolfo M, Lisa T, Alessandra M, et al., 2017, Foveal Avascular Zone Area and Parafoveal Vessel Density Measurements in Different Stages of Diabetic Retinopathy by Optical Coherence Tomography Angiography. Int J Ophthalmol, 10(10): 1545–1551.

Yu H, Teng J, Zhu G, 2023, Quantitative Analysis of Retinal and Choroidal Blood Flow Perfusion Around the Optic Disc in Patients With Diabetic Retinopathy. Recent Advances in Ophthalmology, 43(01): 44–46.

Qian X, Wang J, Chu T, et al., 2023, Correlation Between Choroidal Thickness and Vascular Density and the Severity of Diabetic Retinopathy. Journal of Clinical Ophthalmology, 31(03): 211–214.

Rosen RB, Andrade Romo JS, Krawitz BD, et al., 2019, The Earliest Evidence of Preclinical Diabetic Retinopathy Is Revealed Using Optical Coherence Tomography Angiography Perfused Capillary Density. American Journal of Ophthalmology, 203: 103–115.

Pramil V, Levine ES, Waheed NK, 2021, Macular Vessel Density in Diabetic Retinopathy Patients: How Can We Accurately Measure It and What Information Can It Provide? Clinical Ophthalmology, 15: 1517–1527.