Vascular dynamics in diabetic retinopathy: A systematic review and meta-analysis of ophthalmic Doppler indices in diabetic and non-diabetic populations
In brief
Resistive index up 0.08 in diabetics without retinopathy, climbs with disease
In a meta-analysis of 14 studies (1,217 participants), people with diabetes but no retinopathy showed a modest rise in ophthalmic artery resistive index (about 0.08) and pulsatility index, while established diabetic retinopathy was linked to lower retinal artery flow velocities and higher resistive index. These Doppler measures may flag microvascular damage, but prospective trials are needed before they guide screening.
- Journal
- Diabetes & vascular disease research (Q1)
- Published
- 18 August 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Muchtar Hanafi, Tonang Dwi Ardyanto, Widiastuti Soewondo, Eti Poncorini Pamungkasari, Muthmainah, Wachid Putranto, et al.
- PMID
- 42610439
- DOI
- 10.1177/14791641261476327
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 23 August 2026): Systematic review of Doppler indices as DR markers
Abstract
BackgroundOphthalmic Doppler ultrasonography is a non-invasive technique for evaluating hemodynamic changes in diabetic patients. This meta-analysis assessed ophthalmic Doppler indices in diabetic patients with and without retinopathy compared to non-diabetic controls.MethodsWe searched Scopus, PubMed, ScienceDirect, and SpringerLink for studies investigating Doppler ultrasound parameters in diabetic retinopathy (DR). Pooled mean differences with 95% confidence intervals were estimated using random-effects models for peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI). Study quality was assessed using QUADAS-2 and QUADAS-C.ResultsFourteen studies (1,217 patients) were included. People with diabetes without retinopathy showed significantly elevated RI (MD 0.08, P=0.004) and PI (MD 0.30, P<0.0001) in the ophthalmic artery versus controls. The central retinal artery showed marked reductions in PSV and EDV (P<0.00001) and increased RI (P=0.001) in established DR. RI was also elevated in the posterior ciliary artery across all diabetic stages. Diagnostic accuracy analyses yielded pooled RI sensitivity of 0.73-1.00 and PI sensitivity of 0.79-1.00.ConclusionOphthalmic artery Doppler indices, particularly RI and PI, were associated with DR severity that may represent possible additional markers of microvascular dysfunction. However, these findings require confirmation in well-designed prospective studies before RI and PI can be considered established early markers.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.