Foveal Avascular Zone Research Articles

This study aimed to evaluate fundus microvascular alterations in patients with familial hypercholesterolemia (FH) using Optical Coherence Tomography Angiography (OCTA). We employed paired sample t-tests and Wilcoxon Signed-Rank Tests to compare vessel density (VD) and retinal ultrastructure between FH patients and healthy controls, as well as between homozygous FH (HoFH) patients and controls. The relationship between VDs, serum cholesterol levels, and clinical symptoms in the HoFH group was analyzed using Generalized Estimating Equation (GEE) analysis. 19 eyes from FH patients and 19 eyes from healthy controls were included. FH eyes exhibited a larger foveal avascular zone (FAZ) area (0.341 ± 0.111 vs. 0.275 ± 0.07; p = 0.031). VDs in the superficial capillary plexus (SCP) were significantly lower in the FH group for the whole image (49.59 ± 2.39% vs. 51.45 ± 2.03%; p = 0.018), as well as in the parafoveal and perifoveal areas (all p < 0.016). Conversely, VDs in the deep capillary plexus (DCP) subsectors were significantly increased (all p < 0.05). Total cholesterol (TC) levels were negatively correlated with VDs in the SCP (all p < 0.05), while high-density lipoprotein cholesterol (HDL-C) levels showed positive correlations with VDs in the radial peripapillary capillary (RPC) in the peripapillary area (odds ratio [OR] 4.22, 95% confidence interval [CI] 2.68 to 5.78, p < 0.001)). Higher DCP perifoveal VDs were associated with more severe cardiovascular symptoms (OR 2.67, 95% CI 0.33 to 5.01, p = 0.025). FH patients exhibited significant microvascular alterations, with specific VDs correlating with serum cholesterol levels and cardiovascular symptoms in HoFH patients.

The purpose of this study was to investigate and compare the retinal and choroidal vasculature between healthy subjects and the fellow eyes of patients with rhegmatogenous retinal detachment (RRD). We recruited patients with unilateral RRD and healthy controls. An ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA) was applied to measure the retinal and choroidal vessel densities across the entire image and nine quadrants. Additionally, we used ultra-widefield scanning light ophthalmoscopy (UWF-SLO) to capture the fundus lesions in the fellow eye of the patients with RRD. The study recruited 53 healthy subjects and 42 patients with unilateral RRD. The fellow-eye RRD group had a significantly larger foveal avascular zone (FAZ; P = 0.006) and reduced choroidal thickness (CT) compared to the control group. Furthermore, the fellow-eye RRD group showed significantly lower retinal vessel densities in superficial vascular plexus (SVP; P = 0.024), full retinal layer (P = 0.019), and choroidal parameters, including choroidal vascularity volume (CVV; P = 0.016), choroidal vascularity index (CVI; P = 0.030), and choroidal stromal volume (CSV; P = 0.031). Pigmentary lesions (28.6%), lattice degeneration (16.7%), and retinal hole (4.8%) were found by SLO images. Some cases did not reveal morphological abnormalities in the retina, but choroidal vessel loss was evident on OCTA. These results suggest the early abnormalities in retinal and choroidal blood perfusion in the fellow-eye RRD group, which may provide potential pathophysiology and clinical applications. The study underscores the fundus alterations in the fellow eyes of patients with RRD, as detected by OCTA and UWF-SLO.

Predicting Progression to Vision-Threatening Complications in Diabetic Retinopathy.

The present study evaluated the changes in retinal vascular structure among patients with retinal vein occlusion (RVO) according to varying cardiovascular risk (CVR) scores. We analyzed clinical data, blood tests, ophthalmic exams, and macular vascular parameters measured with optical coherence tomography angiography (OCTA) and CVR scores. This study included 21 patients with central retinal vein occlusion (CRVO), 35 patients with branch retinal vein occlusion (BRVO), and 60 control subjects with refractive disorders and no other abnormalities. In eyes with RVO, macular vascular densities in the superficial capillary plexus were significantly lower in all quadrants compared with controls (P < .05), while in the deep capillary plexus, significant reductions were observed in all quadrants except the nasal quadrant (P < .05). Both superficial and deep foveal avascular zone (FAZ) areas were significantly larger in RVO eyes compared with the control group (P < .001 for all). CVR scores were significantly higher in RVO patients compared with the control group (P < .001 for all). CVR scores were highest in CRVO patients (P < .001). Deep FAZ areas showed positive correlations with CVR scores. The present findings suggest that cardiovascular disease risk should be assessed in patients with RVO.

The eyes and the central nervous system (CNS) develop from the same embryonic tissue which explains why retinal changes have been observed in various neurological and neurodegenerative diseases. These changes can be visualized in vivo on acellular and subcellular level using optical coherence tomography (OCT). This article summarizes which retinal changes occur and how these could be used as potential biomarkers of neurodegenerative diseases. The article gives an overview of the literature on the relationship between neurodegeneration, OCT-based retinal characteristics and cognitive functions. A literature search was carried out in PubMed until February 2025. The search terms "neurodegeneration", "dementia", "mild cognitive impairment", "mild neurocognitive disorder", "OCT", "OCT angiography (OCT-A)", "retinal biomarkers", "retinal layer", "RNFLT", and "GCL" were used. Relevant publications were reviewed, analyzed and summarized. In OCT‑A Alzheimer's disease, frontotemporal dementia, vascular dementia, amyotrophic lateral sclerosis, multiple sclerosis (MS) and Parkinson's disease demonstrate an association with areduced retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) thickness as well as an enlarged foveal avascular zone. So far retinal changes could not be specifically assigned to aparticular form of neurodegenerative disease,; however, they could be meaningful in neuropsychological/radiological examinations and for longitudinal monitoring, as already recommended for MS. Further longitudinal studies are needed to identify and validate retinal biomarkers (patterns).

Macular pigment optical density (MPOD) models enhance understanding of macular xanthophyll distribution, particularly relevant to age-related macular degeneration. This study investigates an existing model and introduces a novel, more accurate and biologically relevant approach. MPOD spatial profiles of 48 eyes were obtained using dual-wavelength autofluorescence imaging, with structural data from OCT and OCT-angiography. MPOD data were analyzed using (a) an existing sum of exponential and Gaussian model (MEG) and (b) a novel sum of three Gaussians model (M3G). Extracted parameters generated individualized MPOD models, from which gradients and volumes were derived. M3G-derived variables were analyzed against OCT/OCTA data using factor analysis and multiple regression. M3G demonstrated a superior fit to MPOD data (SSE = 2.60 × 10− 3) compared to MEG, (SSE = 35.7 × 10− 3) enabling automated fitting consistent over small and large datasets. M3G provided meaningful variables, including MPOD gradients, volumes and critical point eccentricities. Correlations included those between dependent variables of critical point eccentricities and central macular pigment volume with foveal avascular zone and foveal pit radii.The excellent data fit of M3G enables automated extraction of physiologically relevant parameters. Its three-component configuration is consistent with the location of macular xanthophylls. M3G is similar to models of foveal structure, suggesting a fundamental relationship.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-21681-4.

To assess optical coherence tomography angiography (OCTA) changes in acute nonarteritic anterior ischemic optic neuropathy (NAION) eyes compared to fellow unaffected eyes and describe the longitudinal OCTA changes within the first 12 weeks of onset while the disc is still edematous. A prospective observational study. A total of 30 patients, diagnosed with unilateral acute NAION, were included. Bilateral OCT and OCTA of the macula and optic nerve head (ONH) were done. Scans were performed at presentation and then at 6 weeks and 12 weeks thereafter. Nerve fibre layer thickness (NFLT) and ganglion cell complex thickness (GCC) were significantly lower in diseased eyes after resolution of edema. Similarly, ONH and peripapillary vessel densities were significantly reduced in NAION eyes throughout the three visits, while macular superficial vessel density demonstrated a statistically significant decrease only from the second visit onward. Conversely, deep macular and foveal avascular zone (FAZ) vessel density (VD) showed no significant change in NAION eyes except at the third visit with lower VD in NAION eyes. However, all VD biomarkers of NAION eyes, including deep macular and FAZ VD, demonstrated a significant decrease in the 6-week and 12-week visits compared to baseline. OCTA VD changes in NAION demonstrated a temporal sequence where radial peripapillary capillary vascular density was the first to decrease, followed by macular superficial vascular density and last the macular deep vascular density. Moreover, there was a progressive decrease in all OCTA VD measurements in NAION eyes during follow-up.

To evaluate the microvascular differences in macular retina and choriocapillaris (CC) between offspring born to mothers with gestational diabetes mellitus (GDM) and unexposed controls. This population-based cross-sectional study was based on the Nanjing Eye Study. Children 7 years old completed detailed ocular examinations in 2019. Quantitative parameters of ocular microvasculature in the macular region were assessed using optical coherence tomography angiography (OCTA) and information about pregnancy and birth history was obtained from a comprehensive questionnaire. Generalized linear models were performed to assess associations between maternal GDM and ocular OCTA parameters adjusted for confounding factors. A total of 681 children (mean age ± SD, 7.44 ± 0.27 years) had complete eye examination and questionnaire data, among whom 41 (6.0%) were born to mothers with GDM. In generalized linear models, offspring exposed to maternal GDM had significantly increased vessel density (VD) of the deep vascular complex (DVC) in the parafoveal temporal quadrant (difference = 1.238, P = 0.025), larger size of CC flow voids (difference = 0.134, P = 0.040), and larger area of CC flow voids (difference = 0.558, P = 0.018) compared with unexposed offspring. No significant differences were observed between the two groups in VD of superficial vascular complex, foveal avascular zone, macular thickness, or subfoveal choroidal thickness (all P > 0.05). Our data showed that GDM offspring have decreased CC perfusion and increased VD of DVC compared with normal peers. These findings suggest that GDM has a potential effect on ocular microvasculature in offspring. This study indicates that greater attention should be paid to eye growth and development in GDM offspring.

BackgroundAccurate segmentation of the foveal avascular zone (FAZ) is valuable for retinal imaging, as FAZ alterations are key biomarkers for diabetic retinopathy (DR). This study presents an automated framework exploring the feasibility of FAZ segmentation and DR classification using optical coherence tomography angiography (OCTA) images.MethodsIn this cross-sectional study conducted at Farabi Eye Hospital, Tehran, Iran, a two-step deep learning pipeline was developed. First, a neural network combining DeepLabv3+, EfficientNetB0, Squeeze-and-Excitation (SE) blocks, and Atrous Spatial Pyramid Pooling (ASPP) was trained to segment the FAZ from superficial capillary plexus (SCP) and deep capillary plexus (DCP) OCTA slabs. Second, a GoogLeNet-based convolutional neural network (CNN) classified segmented FAZ images into binary (normal vs. DR) and three-class (normal, non-proliferative DR [NPDR], proliferative DR [PDR]) categories to differentiate DR stages based on FAZ shape characteristics. For the classification task using the deep learning-generated segmented FAZ images as input, the data was split into 70% training, 10% validation, and 20% testing, with 5-fold cross-validation to mitigate overfitting. Data augmentation and Synthetic Minority Oversampling Technique (SMOTE) were applied to improve classification performance.ResultsThe final dataset comprised 253 OCTA scans (126 SCP, 127 DCP) from 161 eyes of 161 participants (one eye per participant), with 39 normal participants (24.2%), 78 patients with NPDR (48.4%), and 44 with PDR (27.3%). The mean age was 49.7 ± 11.8 years, and 54% were male. The FAZ segmentation network achieved a Dice similarity coefficient (DSC) of 97.5% across the dataset, achieving high precision even in challenging images. The classification model, using the deep learning generated segmented FAZ images as input, reached an area under the curve (AUC) of 100% for binary classification (normal vs. DR) and 87% for three-class classification (normal, NPDR, PDR) with oversampling.ConclusionThis system, with its potential for integrating into clinical workflows, offers a promising assistive tool for clinicians, which could enable earlier and more accurate diagnosis of diabetic retinopathy from OCTA images.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12886-025-04473-2.

BackgroundMild cognitive impairment (MCI) is an intermediate stage between normal aging and Alzheimer's disease (AD). Diabetes mellitus (DM) increases the risk of cognitive decline and may accelerate progression to AD. Retinal changes observed through non-invasive imaging techniques could reflect early neurodegenerative processes.ObjectiveTo compare the influence of DM on cognitive impairment and its possible association with AD-related changes by evaluating retinal structural and vascular alterations in MCI patients, and their relationship with neuropsychological performance.MethodsA cross-sectional study of association between neuropsychological and ophthalmological variables was carried out on a sample of 40 patients divided into two groups: 20 MCI patients and 20 DM-MCI patients.ResultsA decrease in the ganglion cell layer (GCL) and foveal avascular zone (FAZ) with increased arteriolar thickness at the papilla exit and superficial capillary plexus (SCP) has been demonstrated in DM-MCI patients compared to those with MCI. In the DM-MCI group, decreased GCL thickness and increased arteriolar thickness correlate with memory impairment. On the other hand, in the MCI group an increase in FAZ area and SCP show greater memory impairment, while an increase in arteriolar thickness correlates with greater executive function impairment.ConclusionsDM and MCI influence the development of retinal damage that could predict the development of AD as they maintain correlation with the impairment of cognitive domains assessed by different neuropsychological tests. Retinal neurovascular changes assessed by optical coherence tomography angiography may be informative of early cerebral alterations in MCI.

The study aims to examine vascular changes in the optic disc and macular region using Optical Coherence Tomography Angiography (OCTA) in patients with Neuro-Behçet's disease without ocular involvement. 36 eyes of 19 parenchymal Neurobehçet patients without ocular pathology were included in the Neurobehçet group (NBG). As controls, 44 eyes of 22 nonocular Mucocutaneous Behçet's disease patients (MBG) and 51 eyes of 26 healthy individuals (HG) matched by age and gender were included. Full ophthalmological examination and OCTA measurements were performed in all groups. In the comparison of mean peripapillary retinal nerve fiber layer thickness, NBG had the lowest value, while no significant difference was observed between groups. In the analysis of peripapillary vascular density (VD), mean VD in the inferior quadrant was significantly lower in NBG than in the other two groups (p = 0.014). In the foveal region, both superficial capillary plexus and deep capillary plexus VD means were significantly lower in NBG compared to MBG (p = 0.019 and p = 0.02, respectively). Additionally, NBG had significantly wider foveal avascular zone compared to MBG (p = 0.035). In the assessment of choriocapillaris flow rate, mean values for NBG in both the 1mm and 6mm diameter areas were significantly lower than those in other groups (p = 0.002, p = 0.000, respectively). The ability of OCTA to demonstrate changes in retinal and choroidal blood flow in Neuro-Behçet patients without ophthalmological symptoms or findings suggests the presence of subclinical effects and indicates the potential utility of OCTA in monitoring these patients.

Background: Retinal microvascular changes may serve as biomarkers for disease activity in multiple sclerosis (MS). This study evaluated macular and peripapillary vascular plexus densities using optical coherence tomography angiography (OCTA) in patients with relapsing MS (RMS) and healthy controls (HCs), exploring their association with disease activity based on the NEDA-3 concept. Methods: In a cross-sectional study, 117 RMS patients and 37 HCs underwent OCTA imaging. Parameters analyzed included superficial vascular plexus (SVP), deep vascular plexus (DVP), foveal avascular zone (FAZ), and radial peripapillary capillary (RPC) density. Images with artifacts were excluded. Associations between OCTA metrics and demographic, clinical, and MRI volumetrics, as well as NEDA-3 status, were evaluated using multivariate generalized estimating equations. Receiver operating characteristic (ROC) curves assessed predictive capacity. Results: Compared to HCs, MS eyes with prior optic neuritis showed significantly lower SVP density (p < 0.05). DVP and FAZ parameters did not differ between groups. SVP and DVP densities correlated with age, disease duration, relapse history, and MRI volumetrics, including gray matter and whole brain volume. SVP density predicted NEDA-3 status (AUC = 0.82), while DVP also showed predictive value (AUC = 0.64). FAZ FD (Foveal density) was associated with gray matter and whole brain atrophy (AUC = 0.62–0.61). Conclusions: Retinal vascular alterations correlate with clinical and MRI measures in MS. Reduced SVP and DVP densities may serve as markers of recent disease activity, and FAZ metrics reflect neurodegeneration. OCTA may be a valuable non-invasive tool for monitoring MS progression.

PurposeTo define decade-stratified normative values for vascular parameters obtained from optical coherence tomography angiography (OCTA) in healthy eyes and to evaluate their utility for predicting biological ocular age using artificial intelligence.MethodsThis cross-sectional pilot study included 136 rigorously screened healthy subjects aged 10–80 years. Spectral-domain OCT and OCTA scans were acquired using the Optovue Solix platform. Structural and vascular features were extracted from both the macular and optic disc regions. Vessel density (VD) metrics were calculated in the superficial capillary plexus using the ETDRS grid (macula) and Garway-Heath segmentation (peripapillary). Foveal avascular zone (FAZ) area, FAZ circularity, and FD-300 density were also analysed. Disc and RNFL metrics were included. Age-stratified normative values were derived, and a support vector regression (SVR) model was developed to estimate biological ocular age based on structural-only, vascular-only, and combined imaging inputs. Model performance was evaluated using root mean squared error (RMSE) and R² under subject-level grouped cross-validation.ResultsVessel density in the macular and peripapillary regions declined progressively with age, particularly after the fifth decade. FAZ area increased, and circularity decreased with age, while FD-300 density remained relatively stable. The SVR model trained on OCTA-only features showed modest predictive performance (R² = 0.268), while the structural OCT-only model performed poorly (R² = 0.296). Combining structural and vascular features achieved a highly accurate age prediction model (R² = 0.895; RMSE = 5.025 years and MAE of 4.024) under subject-level cross-validation.ConclusionThis pilot study provides decade-stratified normative OCTA metrics and demonstrates that combining OCT and OCTA features significantly enhances AI-based ocular age estimation. These findings offer a promising foundation for early glaucoma risk stratification through biologically meaningful ocular age prediction.

Purpose: To evaluate the long-term effects of smoking on retinal microcirculation and choriocapillaris flow, and to compare microvascular alterations between healthy smokers and nonsmokers using optical coherence tomography (OCT) angiography. Methods: A total of 160 patients (86 smokers, 74 nonsmokers) were enrolled in this prospective, cross-sectional study. Non-flow and foveal avascular zone (FAZ) parameters, vessel density parameters of the macula and optic disc, and choriocapillaris flow area were obtained using OCT angiography. Results: The mean FAZ area in the whole retina and FAZ perimeter were significantly larger in the smoker group compared with the nonsmoker group (P = .003 and P = .002, respectively). Significant differences were also observed in vessel density of the superficial and deep capillary plexus, except in some zones of superficial perifovea, deep perifovea, and deep parafovea. No significant differences were found in vascular density of the optic disc region between groups (P > .05) The choriocapillaris flow within the 3 mm radius area was lower in smokers than in nonsmokers (P < .05). Conclusions: Cigarette smoking was associated with reduced retinal and choroidal vascularity as measured by OCT angiography. These findings support a potential detrimental role of smoking in the development of ocular diseases.

PurposeTo evaluate the area of the superficial foveal avascular zone (SFAZ) and deep foveal avascular zone (DFAZ) in patients with systemic lupus erythematosus (SLE) using optical coherence tomography angiography (OCT-A) and to associate the SFAZ and DFAZ areas with medication.DesignA cross-sectional observational study.Patients and MethodsThis study included 36 eyes of 36 SLE patients and 33 eyes of 33 healthy controls. SFAZ, DFAZ, and central retinal thickness (CRT) were measured using Spectralis OCT-A. Data on medical history and medications were collected to determine associations with SFAZ and DFAZ areas.ResultsSFAZ and DFAZ areas showed no significant association with hydroxychloroquine/chloroquine duration or immunosuppressive therapy (p>0.05).ConclusionThe SFAZ and DFAZ areas in patients with SLE were not significantly larger than those in healthy controls. However, the CRT was significantly thinner.

PurposeTo determine the multifractal and lacunarity characteristics of the retinal microvasculature in patients with migraine and compare with healthy controls.MethodsA total of 177 eyes from 56 migraine patients (35 without aura, 21 with aura) and 102 eyes from 51 healthy controls were included. Optical coherence tomography angiography (OCTA) was used to assess foveal and parafoveal vascular parameters. Vascular area density, vascular length density, vascular diameter index, vascular tortuosity, branch point density, non-flow area, and foveal avascular zone parameters were measured with ImageJ. Fractal dimensions (D₀, D₁, D₂), multifractal spectrum (D(q)), and lacunarity (parameter b) were calculated using MATLAB.ResultsMigraine with aura patients showed significantly reduced vascular area density, vascular length density, vascular diameter index, and branch point density values, particularly in the deep capillary plexus. The foveal avascular zone area and perimeter were significantly enlarged in the migraine with aura group. Fractal analysis revealed a significant decrease in D₀, D₁, and D₂ values in migraine with aura, especially in the deep capillary plexus. The multifractal spectrum (D(q)) exhibited a consistent downward shift in migraine with aura, suggesting global architectural simplification. Although not statistically significant, lacunarity analysis showed a trend toward increased spatial heterogeneity in migraine with aura, reflected by lower b values.ConclusionMigraine, particularly with aura, is associated with reduced vascular complexity and increased spatial irregularity in the retinal microvasculature, especially at the level of the deep capillary plexus. Multifractal and lacunarity metrics may serve as sensitive indicators of subclinical microvascular disruption in migraine.

PurposeThe present study aimed to compare macular and peripapillary vascular density values measured by optical coherence tomography angiography (OCTA) in different types of amblyopia (ametropic amblyopia, anisometropic amblyopia, strabismic amblyopia, deprivation amblyopia) with age- and gender-matched healthy controls.Materials and methodsIn this prospective, cross-sectional study, between the ages of 8–18 years, 32 eyes of 32 patients with hypermetropic ametropic amblyopia and 21 amblyopic eyes of 21 patients with hypermetropic anisometropic amblyopia, 15 amblyopic eyes of 15 patients with strabismic amblyopia due to esotropia, 12 amblyopic eyes of 12 patients with deprivation amblyopia, and 30 eyes of 30 emmetropic individuals aged 8–18 years without any ocular pathology who were admitted to the same clinic were included in the control group. Refractive errors and best-corrected visual acuity (BCVA) with the Snellen chart were recorded as LogMAR. In all cases, superficial vascular plexus and deep vascular plexus whole image vessel density, foveal vessel density, parafoveal vessel density, perifoveal vessel density, and foveal avascular zone area (FAZ) values were measured and recorded for macular vascular density determination with OCTA. The whole image, intrapapillary, and peripapillary vessel density measurements were performed for peripapillary vessel density determination. The Kruskal-Wallis test was used for statistical analysis and the post hoc test was used for inter-group comparisons.ResultsThe mean BCVA (LogMAR) was found to be significantly lower in the anisometropic amblyopia, strabismic amblyopia, and deprivation amblyopia groups (unilateral amblyopia) compared to the ametropic amblyopia (bilateral amblyopia) and healthy group (p < 0.001). The whole image vessel density, foveal vessel density, and parafoveal vessel density of superficial and deep vascular plexus were found to be significantly lower in anisometropic amblyopia, strabismic amblyopia, and deprivation amblyopia compared to ametropic amblyopia and healthy volunteers (p < 0.001). In the correlation analysis, a negative correlation was found between the mean visual acuity in LogMAR and superficial vascular plexus foveal vessel density (p < 0.001, r = − 0.622), superficial vascular plexus parafoveal vessel density (p < 0. 001, r= -0.556), deep vascular plexus foveal vessel density (p < 0.001, r= -0.636), and deep vascular plexus parafoveal vessel density (p < 0.001 r=-0.596).ConclusionSuperficial and deep vascular plexus vessel densities in the macular region are affected in anisometropic amblyopia, strabismic amblyopia, and deprivation amblyopia, and OCTA may be useful in detecting these changes.

To evaluate the association between foveal avascular zone (FAZ) parameters (area, perimeter and circularity) with macular high density perimetry (Octopus Macular program), macular vessel density (mVD) and ganglion cells layer thickness (GCLT) in glaucoma patients. This cross-sectional study included 89 eyes from 57 glaucoma patients. All participants underwent high-density perimetry (Octopus 900 Macular and G programs). FAZ metrics and mVD were obtained via Optical Coherence Tomography Angiography (OCTA) (Triton, Topcon), and GCLT was measured across global, superior, and inferior sectors. FAZ parameters were automatically extracted using ImageJ with axial length correction. Structure-structure and structure-function associations were assessed using mixed-effects linear regression models, adjusting for inter-eye correlation, age, and GCLT when appropriate. Mean age was 66.67 ± 7.49 years old. FAZ area and perimeter were significantly associated with mean defect of macular program (mMD), central mVD, and GCLT (p < 0.05). FAZ area remained significantly associated with GCLT even after controlling for age (p < 0.05). FAZ perimeter and circularity were independently associated with age. FAZ perimeter and circularity were mainly age-related, while area was linked to glaucomatous damage. FAZ parameters were more strongly related to superior than inferior GCLT. Glaucoma severity was categorized using Brusini's Glaucoma Staging System. Higher mMD values were observed in more advanced stages of glaucoma. FAZ morphology reflects both glaucomatous damage and age-related vascular changes. By controlling for confounding variables, this study reinforces the role of FAZ metrics as complementary biomarkers for assessing structure-function relationships in glaucoma. High-density macular perimetry further improves spatial correspondence with anatomical alterations.

PurposeTo evaluate the association between foveal avascular zone (FAZ) parameters (area, perimeter and circularity) with macular high density perimetry (Octopus Macular program), macular vessel density (mVD) and ganglion cells layer thickness (GCLT) in glaucoma patients.MethodsThis cross-sectional study included 89 eyes from 57 glaucoma patients. All participants underwent high-density perimetry (Octopus 900 Macular and G programs). FAZ metrics and mVD were obtained via Optical Coherence Tomography Angiography (OCTA) (Triton, Topcon), and GCLT was measured across global, superior, and inferior sectors. FAZ parameters were automatically extracted using ImageJ with axial length correction. Structure–structure and structure–function associations were assessed using mixed-effects linear regression models, adjusting for inter-eye correlation, age, and GCLT when appropriate.ResultsMean age was 66.67 ± 7.49 years old. FAZ area and perimeter were significantly associated with mean defect of macular program (mMD), central mVD, and GCLT (p < 0.05). FAZ area remained significantly associated with GCLT even after controlling for age (p < 0.05). FAZ perimeter and circularity were independently associated with age. FAZ perimeter and circularity were mainly age-related, while area was linked to glaucomatous damage. FAZ parameters were more strongly related to superior than inferior GCLT. Glaucoma severity was categorized using Brusini’s Glaucoma Staging System. Higher mMD values were observed in more advanced stages of glaucoma.ConclusionsFAZ morphology reflects both glaucomatous damage and age-related vascular changes. By controlling for confounding variables, this study reinforces the role of FAZ metrics as complementary biomarkers for assessing structure-function relationships in glaucoma. High-density macular perimetry further improves spatial correspondence with anatomical alterations.

To assess the prevalence and degree of retinal vascular abnormalities in retinopathy of prematurity (ROP)-treatment naïve adults born preterm with very low birth weight (VLBW; birth weight < 1500g). Both eyes of 64 VLBW participants and 81 term-born controls from the Finnish birth cohort were examined at mean age of 38 years. Macular developmental arrest (MDA) and foveal avascular zone (FAZ) were assessed from optical coherence tomography (OCT) and angiography (OCTA) images, and peripheral avascular retina (PAR) from Optos® widefield-images and analyzed with co-effect of perinatal and cardiovascular factors. The FAZ of VLBW eyes was smaller (p<0.001) than that of control eyes and showed a strong association with MDA (OR 13.90, p<0.001). All eyes had normal visual acuity. FAZ size below the fifth control percentile was recorded in 57% and totally vascularized fovea in 14% of the VLBW eyes. Twenty-three percent of the VLBW eyes had PAR, and this was associated with MDA (OR 3.39, p = 0.029) and hypertension (OR 3.96, p = 0.008). Regressed ROP -like retinal features were recorded in 20% of the VLBW eyes. Uncomplicated PAR and small, or even absent, FAZ are frequently seen as a natural course of retinal vascularization in adults born preterm with VLBW.