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, 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.