Abstract
PURPOSE: To evaluate and quantify diabetes-related retinal and choroid perfusion changes in individuals with and without high myopia and explore their associations with diabetes risk factors. METHODS: Diabetic patients [n = 133; 43 without diabetic retinopathy in group DM; 48 non-proliferative diabetic retinopathies in group DR; 42 without DR but with high myopia in group HM] underwent ophthalmological and endocrinological examinations. Swept-source optical coherence tomography angiography (SS-OCTA) was used to image the retinal vessel density (RVD), retinal thickness (RT), choroidal thickness (CT), choriocapillaris vessel perfusion (CPV) and choroidal vascularity index (CVI). Automatic segmentation of retinal and choroidal layers was performed using a deep learning-based U-Net architecture. A ResNet-50 convolutional neural network was further applied to analyze vascular density patterns and assist in DR grading. Univariate and multiple linear regression analyses explored the associations between perfusion and risk factors. RESULTS: The inner ring retinal vessel density and CVI in all areas were significantly different between groups (P < 0.05); CPV was not significantly changed except for the inferotemporal area among the groups. CT was decreased in all areas between groups (P < 0.05). The visual impairments in HM group was more obvious correlation with the retinal and choroidal structural changes. The AI-driven analysis revealed that decreased CVI and CT were significantly associated with age and spherical equivalent (SE), highlighting the utility of automated algorithms in identifying early microvascular impairments. CONCLUSION: Diabetic patients with high myopia exhibited significantly lower CVI compared to those with diabetic retinopathy, indicating that CVI monitoring could facilitate risk stratification of diabetic retinopathy progression. The integration of SS-OCTA with artificial intelligence-enhanced segmentation and vascular analysis provides a refined method for early detection of retinal and choroidal microvascular impairments in diabetic populations.