Abstract： Objective The aim of this study was to investigate the feasibility of using retinal microaneurysms(MAs)as predictors of the severity of diabetic retinopathy(DR).Methods This retrospective study included 100 pa-tients(100 eyes)diagnosed with type 2 diabetes from January 1,2020,to December 31,2022,at our hospital.Fundus photography and fundus examination with ophthalmoscopy were performed on all eyes.The quantitative relationship be-tween retinal MAs,hemorrhages(Hmas),hard exudates(HEs),and the severity of DR was evaluated.Results The quan-tified MAs in images of patients without DR were negligible,while the average number of MAs increased significantly with the severity of non-proliferative diabetic retinopathy(NPDR),ranging from mild to severe.Hmas were detected in patients with moderate and severe NPDR.The combined average values of MAs and Hmas,represented by RLs,followed the same trend as quantified MAs alone,but their values were higher due to the influence of Hmas.Lastly,HEs were not detected in patients without NPDR or with mild NPDR,but were present in patients with moderate and severe NPDR.There were sta-tistically significant differences in the quantification of retinal lesions among different severity levels of DR.Conclusions In color fundus photographs(CFP)of the macula,retinal lesions can be quantified to assess the severity of DR,showing a strong correlation.Furthermore,MAs and Hmas,as quantifiable variables of disease severity in fundus images,can serve as relevant efficacy endpoints in clinical trials.