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Background: With the development of the economy and improvements in living standards, the incidences of diabetes mellitus (DM) and diabetic retinopathy (DR), which is a complication of DM, are on the rise., Aim: To analyze early DR in patients with macular zone changes in biological images using optical coherence tomography angiography., Methods: A prospective case study was performed on 59 participants: 35 healthy eyes (control group), 35 eyes with diabetes but no DR group (no DR group), and 35 eyes with mild DR (NPDR group). All quantitative comparisons of parameters, including the fovea vascularity area, circularity index, and vascular complexity parameters, were performed using a biological image analysis software., Results: The foveal avascular zone (FAZ) area, FAZ circularity index, number of branches in the area, and the total of the single branches' length in the area was 0.366 ± 0.031, 0.834 ± 0.037, 3241.8 ± 268.3, and 3.860 × 10 7 ± 0.194 × 10 7 , and 0.421 ± 0.030, 0.739 ± 0.023, 2956.6 ± 476.4, and 3.177 × 10 7 ± 0.161 × 10 7 in the no DR group and the NPDR group, respectively, which were significantly different from the corresponding parameters of the control group ( P < 0.05). Moreover, there were significant differences between these two groups ( P < 0.05)., Conclusion: This study shows that early microcirculation changes in the macular area of the retina is associated with disease progression. Early changes in DR can be analyzed using optical coherence tomography angiography., Competing Interests: Conflict-of-interest statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)