ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Multimodal Imaging Features of Non-Proliferative and Proliferative Diabetic Retinopathy Based on SD-OCT and Fundus Autofluorescence
Zixun Wang 1,2
Chenxi Ji 3,2
Xiaoxue Hu 4
Tingyu Zhang 1
Tingxi Liu 2
Xiaoling Zhang 5
Yuhang Wang 1
Zhiqing Li 1
Xiuhong Qin 2
Ming Sun 4
1. Tianjin Medical University Eye Hospital, Tianjin, China
2. The First Affiliated Hospital of Dalian Medical University, Dalian, China
3. Xi'an Gaoling District Hospita, Xian, China
4. Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China, Wuhan, China
5. Handan Eye Hospital (The Third Hospital of Handan), Hebei, China, Handan, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Purpose To characterize and compare multimodal imaging features of non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) using spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). Method This cross-sectional observational study included 132 patients (219 eyes) with DR (120 NPDR eyes and 99 PDR eyes) and 73 healthy controls (129 eyes). All participants underwent comprehensive ophthalmic examinations, including fundus photography, fundus fluorescein angiography (FFA), FAF, and SD-OCT. OCT biomarkers, including hyperreflective foci (HRF), intraretinal cystic cavities (IRC), diabetic macular edema (DME), disorganization of retinal inner layers (DRIL), epiretinal membrane (ERM), posterior vitreous detachment (PVD), subretinal fluid (SRF), and disruption of the external limiting membrane (ELM) and ellipsoid zone (EZ) were systematically evaluated and compared between groups. Results HRF, IRC, DME, PVD, and ERM were significantly more frequent in PDR eyes than in NPDR eyes (all P < 0.05). ERM was highly prevalent in both NPDR (80.0%) and PDR (84.8%) eyes. FAF effectively demonstrated intraretinal and preretinal hemorrhages, DME, and fibroproliferative membranes, while SD-OCT provided superior visualization of microstructural retinal alterations. Subfoveal choroidal thickness was significantly increased in both NPDR and PDR compared with healthy controls (P < 0.05), but did not differ considerably between NPDR and PDR. Conclusion SD-OCT and FAF provide complementary information for evaluating structural and functional retinal alterations in DR. FAF is particularly useful for visualizing hemorrhage, DME, and fibroproliferative membranes. In contrast, SD-OCT enables detailed assessment of multiple retinal biomarkers. The high prevalence of epiretinal membranes highlights their potential role in DR progression.
Summary
Keywords
Diabetic Retinopathy, Fundus autofluorescence, imaging biomarkers, Macular Edema, Optical Coherence Tomography
Received
01 January 2026
Accepted
06 February 2026
Copyright
© 2026 Wang, Ji, Hu, Zhang, Liu, Zhang, Wang, Li, Qin and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhiqing Li; Xiuhong Qin; Ming Sun
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.