Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Erectile dysfunction and retinal microvascular network: an optical coherence tomography angiography study


The aims of this study were to examine the microvascular network of the retina using the optical coherence tomography angiography (OCT-A) device in patients with erectile dysfunction (ED) and to determine whether the OCT-A values could assist in the differential diagnosis of ED. The study design was prospective, observational, and cross-sectional. The vessel densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and retinal peripapillary capillary plexus (RPCP) were assessed using OCT-A in patients with ED and healthy subjects. All the participants were evaluated and scanned for systemic and hormonal disorders and those with ED also underwent penile Doppler ultrasonography (PDU). After recording the data, the participants were divided into three groups: organic ED, psychogenic ED, and healthy control. The relationships between the OCT-A parameters and other clinical findings were analyzed. The right eyes of 80 patients with ED and 40 healthy volunteers were evaluated in this study. Of the ED patients, 46 were included in the organic ED group according to the results of PDU. The VDs of DCP, SCP, and the temporal sector of RPCP were significantly lower in the organic ED group than the psychogenic ED and healthy control groups. The VDs of SCP and DCP were correlated with the peak systolic velocity of both left and right penile cavernous arteries. The VDs of DCP were also correlated with the left and right resistive indexes. In conclusion, the OCT-A data of SCP and especially DCP could be helpful in evaluating ED, and provide reliable information about the origin of the disease along with the other laboratory testing and penile vascular evaluation.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Optical coherence tomography angiography findings of a patient with organic erectile dysfunction.


  1. 1.

    NIH consensus conference. Impotence: NIH consensus development panel on impotence. J Am Med Assoc. 1993;270:83–90.

  2. 2.

    Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014;65:968–78.

    Article  Google Scholar 

  3. 3.

    Böhm M, Baumhäkel M, Teo K, Sleight P, Probstfield J, Gao P, et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: the ongoing telmisartan alone and in combination with ramipril global endpoint trial/telmisartan randomized assessment study in ACE intoler. Circulation. 2010;121:1439–46.

    Article  Google Scholar 

  4. 4.

    Pastuszak AW. Current diagnosis and management of erectile dysfunction. Curr Sex Heal Rep. 2014;6:164–76.

    Article  Google Scholar 

  5. 5.

    Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, et al. Retinopathy in diabetes. Diabetes Care. 2004;27:s84–7.

    Article  Google Scholar 

  6. 6.

    Wong T, Mitchell P. Hypertensive retinopathy. N Engl J Med. 2004;351:2310–7.

    CAS  Article  Google Scholar 

  7. 7.

    Rastogi N, Smith RT. Association of age-related macular degeneration and reticular macular disease with cardiovascular disease. Surv Ophthalmol. 2016;61:422–33.

    Article  Google Scholar 

  8. 8.

    Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. Prog Retin Eye Res. 2018;64:1–55.

    Article  Google Scholar 

  9. 9.

    Rhoden EL, Telöken C, Sogari PR, Vargas Souto CA. The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int J Impot Res. 2002;14:245–50.

    CAS  Article  Google Scholar 

  10. 10.

    Turunc T, Deveci S, Guvel S, Peskircioglu L. The assesment of Turkish validation with 5 question version of Iinternational index of erectile function (IIEF-5). Turkish J Urol. 2007;33:45–9.

    Google Scholar 

  11. 11.

    Naroda T, Yamanaka M, Matsushita K, Kimura K, Kawanishi Y, Numata A, et al. Clinical studies for venogenic impotence with color Doppler ultrasonography: evaluation of resistance index of the cavernous artery. Jpn J Urol. 1996;87:1231–5.

    CAS  Article  Google Scholar 

  12. 12.

    Yilmaz H, Karakurt Y, Icel E, Ugurlu A, Ucak T, Tasli NG, et al. Normative data assessment of vessel density and foveal avascular zone metrics using AngioScan Software. Curr Eye Res. 2019;44:1345–52.

    Article  Google Scholar 

  13. 13.

    Kouidrat Y, Pizzol D, Cosco T, Thompson T, Carnaghi M, Bertoldo A, et al. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet Med. 2017;34:1185–92.

    CAS  Article  Google Scholar 

  14. 14.

    Seftel AD, Sun P, Swindle R. The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol. 2004;171:2341–5.

    Article  Google Scholar 

  15. 15.

    Zhang Q, Wang D, Wang A, Zhang S, Pan S, Li Y, et al. Relationship of ideal cardiovascular health metrics with retinal vessel calibers and retinal nerve fiber layer thickness: A cross-sectional study. BMC Cardiovasc Disord. 2018;18:1–8.

    Article  Google Scholar 

  16. 16.

    Wasan B, Cerutti A, Ford S, Marsh R. Vascular network changes in the retina with age and hypertension. J Hypertens. 1995;13:1724–8.

    Article  Google Scholar 

  17. 17.

    Henis O, Shahar Y, Steinvil A, Finn T, Heruti R, Loewenstein A, et al. Erectile dysfunction is associated with severe retinopathy in diabetic men. Urology. 2011;77:1133–6.

    Article  Google Scholar 

  18. 18.

    Der-Chong T, Chin-Chou H, Shin-Jen C, Pesus C, Chia-Min C, Wan-Leong C, et al. Increased risk of erectile dysfunction among males with central serous chorioretinopathy—a retrospective cohort study. Acta Ophthalmol. 2013;91:666–71.

    Article  Google Scholar 

  19. 19.

    Laties A, Sharlip I. Ocular safety in patients using sildenafil citrate therapy for erectile dysfunction. J Sex Med. 2006;3:12–27.

    CAS  Article  Google Scholar 

  20. 20.

    Üçgül Atilgan C, Şendül SY, Güven D. Nonarteritic anterior ischemic optic neuropathy in a young male patient taking sildenafil citrate. Retin-Vitreus. 2014;22:149–52.

    Google Scholar 

  21. 21.

    Çakmak H, Dündar SO, Kocatürk T. Choroidal neovascular membrane associated with Sildenafil. Nobel Med. 2014;11:97–99.

    Google Scholar 

  22. 22.

    Chew SKH, Taouk Y, Xie J, Nicolaou TE, Wang JJ, Wong TY, et al. The relationship of retinal vessel caliber with erectile dysfunction in patients with type 2 diabetes. Investig Ophthalmol Vis Sci. 2013;54:7234–9.

    Article  Google Scholar 

  23. 23.

    Bojikian KD, Chen PP, Wen JC. Optical coherence tomography angiography in glaucoma. Curr Opin Ophthalmol. 2019;30:110–6.

    Article  Google Scholar 

  24. 24.

    Moghimi S, Hou H, Rao H, Weinreb RN, et al. Optical coherence tomography angiography and glaucoma: a brief review. Asia-Pac J Ophthalmol. 2019;8:115–25.

    Google Scholar 

  25. 25.

    Holló G. Influence of removing the large retinal vessels-related effect on peripapillary vessel density progression analysis in glaucoma. J Glaucoma. 2018;27:e137–9.

    Article  Google Scholar 

  26. 26.

    Hatzichristou D, Rosen RC, Derogatis LR, Low WY, Meuleman EJH, Sadovsky R, et al. Recommendations for the clinical evaluation of men and women with sexual dysfunction. J Sex Med. 2010;7:337–48.

    Article  Google Scholar 

  27. 27.

    Rudnick J, Bodecker R, Weidner W. Significance of the intracavernosal pharmacological injection test, pharmacocavernosography, artificial erection and cavernosometry in the diagnosis of venous leakage. Urol Int. 1991;46:338–43.

    CAS  Article  Google Scholar 

  28. 28.

    Broderick GA, Arger P. Duplex Doppler ultrasonography: noninvasive assessment of penile anatomy and function. Semin Roentgenol. 1993;28:43–56.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Hayati Yilmaz.

Ethics declarations

Conflict of interest

The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial or nonfinancial interest in the subject matter or materials discussed in this paper.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yilmaz, H., Gultekin, M.H. & Yalcin, A. Erectile dysfunction and retinal microvascular network: an optical coherence tomography angiography study. Int J Impot Res 33, 318–324 (2021).

Download citation


Quick links