Abstract:Diabetic optic neuropathy(DON)is a common yet frequently overlooked complication of diabetes mellitus(DM), characterized by an insidious onset, nonspecific clinical manifestations, and frequent co-occurrence with diabetic retinopathy(DR), which often leads to delayed diagnosis and irreversible optic nerve damage. Optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)provide non-invasive, high-resolution imaging of the retinal layers, choroid, and optic nerve head, enabling detailed visualization of structural and microvascular changes in DON. This review summarizes recent advances in the application of OCT/OCTA for evaluating peripapillary retinal nerve fiber layer(pRNFL)thickness, ganglion cell complex(GCC)integrity and vessel density(VD)in DON, highlighting that microvascular impairment may precede measurable structural loss. Furthermore, the potential of OCT/OCTA in disease staging, treatment monitoring, and its integration with artificial intelligence(AI)for early screening and risk prediction is discussed. By combining structural and hemodynamic metrics, OCT/OCTA holds promise for improving early detection, risk stratification, and precision management of DON, thereby helping to preserve visual function in affected patients.
