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Background and Objective: This study aimed to investigate correlations between photoreceptor and vascular parameters in varying stages of diabetic retinopathy (DR) using adaptive optics (AO) imaging., Patients and Methods: In this single-center, prospective cohort study, 29 participants (46 eyes) were classified into control/mild non-proliferative DR (NPDR), moderate/severe NPDR, and proliferative DR. AO images of photoreceptors and retinal vasculature were analyzed, and Spearman's correlation (ρ) was used to assess relationships between photoreceptor density and vascular parameters., Results: Higher cone density was inversely associated with total vessel (ρ = 0.22, P = 0.03) and lumen diameters (ρ = -0.24, P = 0.01), while higher dispersion was associated with total vessel (ρ = 0.19, P = 0.06) and lumen diameters (ρ = 0.21, P = 0.04). These associations were primarily significant in mild NPDR. No significant correlations were found in advanced DR stages., Conclusion: This study underscores intricate neurovascular correlations in early-stage DR, suggesting these parameters may aid in early disease detection. Further research is needed to understand whether similar correlations exist in advanced DR. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.] .