Optical coherence tomography angiography (OCTA) has revolutionized the evaluation of retinal microvasculature by enabling noninvasive quantification of capillary networks and the foveal avascular zone (FAZ). Diabetic retinopathy (DR) is associated with progressive microvascular rarefaction, but the effect of lens status on OCTA-derived vascular metrics remains underexplored. In this prospective observational study, 107 diabetic eyes imaged between March and August 2025 at Drashti Netralaya underwent high-resolution OCTA using the Heidelberg Spectralis platform. OCTEVA software enabled automated segmentation of the superficial (SCP), intermediate (ICP), and deep capillary plexuses (DCP). Quantitative measurements included vessel area density, branchpoint density, fractal dimension, and FAZ area. Lens status was classified as phakic or pseudophakic. Between-group comparisons were performed using Mann-Whitney U tests with Holm correction for multiple comparisons, and Cohen's d was calculated for effect size. Pseudophakic eyes exhibited significantly reduced vascular density (SCP: 44.7 ± 6.2% vs 48.5 ± 5.9%, P = 0.004; ICP: 33.8 ± 4.5% vs 36.7 ± 4.3%, P = 0.008; DCP: 34.2 ± 4.9% vs 37.9 ± 5.1%, P = 0.005) and lower fractal dimension (SCP: 1.39 ± 0.06 vs 1.42 ± 0.05, P = 0.011). FAZ area was significantly larger in pseudophakic eyes (0.37 ± 0.09 mm² vs 0.32 ± 0.08 mm², P = 0.018). Central macular thickness was slightly increased in pseudophakic eyes but not statistically significant (P = 0.07). Pseudophakic eyes demonstrate measurable microvascular compromise and FAZ enlargement compared with phakic eyes, reflecting advanced diabetic disease burden. Lens status should be considered when interpreting OCTA biomarkers in DR research and clinical assessment.

Optic Disc Microvasculature Reduction and Visual Field Progression in Advanced Primary Open-Angle Glaucoma.

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 longitudinal relationship between carotid arterial disease and retinopathy complicating type 2 diabetes: The Fremantle diabetes study phase II.

Optical coherence tomography angiography (OCTA) is a non-invasive imaging technique that provides depth resolved visualization of microvascular networks without exogenous contrast agents. However, traditional scanning strategies suffer from limitations including non-uniform sampling, incompatible with the BM-scan mode, inflexible field of view (FOV) shapes and data redundancy due to unnecessary coverage of non-target areas. To address these issues, this study proposes a novel targeted ROI scanning strategy for OCTA that enables customizable FOVs while ensuring uniform spatial and temporal sampling. As a proof of concept, we use a circular FOV to simulate that of optical systems and the eye, showcasing its efficiency. The proposed strategy integrates uniform spatial and temporal sampling mechanisms. It discretizes the ROI into evenly distributed sampling points, groups them into equivalent B-scans, and employs a dynamic timing mechanism with flyback compensation to maintain consistent inter-frame intervals. This mechanism supports the widely used BM-scan protocol and avoids the need for post-acquisition resampling, thereby reducing interpolation artifacts and improving computational efficiency. Simulations and in vivo experiments on animal anterior segments and retinas demonstrate that the proposed strategy enables circular FOVs and achieves imaging quality comparable to the traditional raster scanning strategy, while reducing the scanning area to 81.1%, achieving an 18.9% reduction in acquisition time and a 23.3% improvement in scanning efficiency. In summary, the proposed strategy provides a framework with the potential for customizable FOVs and achieves high efficiency without compromising imaging quality, making it highly suitable for OCTA scientific research and clinical diagnosis.

Spectrum of Colopathy and Severe Polyposis Associated With Pentosan Polysulfate Sodium Maculopathy: A Retrospective Case Series.

Swept-Source Optical Coherence Tomography Angiography Vascular Metrics as Biomarkers for Renal Function in Patients with Diabetes Mellitus.

This study aimed to investigate the incidence and distribution characteristics of dark without pressure (DWOP), a relatively underexplored retinal feature, in myopic people based on ultra-widefield swept source optical coherence tomography angiography and ultra-wide field color fundus photography. Subjects were recruited from December 2021 to May 2024 at Sichuan Provincial People's Hospital. Each eye underwent a comprehensive ophthalmic examination, including ultra-wide field color fundus photography and 24 × 20-mm ultra-widefield swept source optical coherence tomography angiography. Eyes were categorized based on spherical equivalent into four groups: emmetropia, mild myopia, moderate myopia, and high myopia. A total of 304 subjects (592 eyes) were recruited. The overall incidence of DWOP was 25.5%. It was significantly higher in the high myopia group (44.3%) compared with the emmetropia group (10.9%) ( P < 0.001). Axial length greater than 26 mm and spherical equivalent less than -6.0 D were associated with increased DWOP risk. DWOP was predominantly found in the inferotemporal mid-periphery (68.9%). Retinal thickness in the DWOP region was 205.0 ± 13.6 µ m, 1.70% lower than that in the normal region ( P = 0.001). Among the 34 eyes followed for 3 to 49 months, 52.4% of eyes showed an increase of DWOP area size, and 28.6% showed a decrease in area size. DWOP is commonly observed in high myopic eyes, primarily in the midperipheral inferior temporal region, with boundaries that change over time. These findings suggest a need for further investigation into the clinical significance of DWOP progression in myopic patients.

Quantitative Analysis of Choroidal Thickness and Blood Flow in Thyroid-Associated Ophthalmopathy Using Ultra-Widefield Swept-Source OCT Angiography.

Macular telangiectasia masqueraders.

To compare macular microvascular and microstructural exploratory imaging findings in patients with childhood-onset mevalonate kinase deficiency (MKD) and healthy controls, and to assess associations with disease activity. This cross-sectional case-control study included patients with childhood-onset, genetically confirmed MKD and healthy controls. Disease activity was assessed using the autoinflammatory disease activity index (AIDAI) score and C-reactive protein (CRP) levels. Choroidal images were obtained to measure subfoveal choroidal thickness (SFCT) and to calculate the total choroidal area (TCA), luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI). Macular optical coherence tomography (OCT) and optical coherence tomography-angiography (OCT-A) parameters were compared between groups, and associations with systemic disease activity were examined. The study included 17 patients with childhood-onset MKD and 30healthy controls. The MKD group showed higher LA and CVI than in controls (p = 0.042 and p = 0.014, respectively), whereas TCA and SA were comparable between groups (p = 0.124 and p = 0.669, respectively). Mean central macular thickness was lower in the MKD group (p = 0.030), while SFCT was comparable between groups (p = 0.325). No significant differences were observed in macular microvascular parameters. Patients with childhood-onset MKD showed higher CVI, whereas macular microvascular parameters were comparable to those of controls. These findings may suggest subtle alterations in choroidal vascular composition, potentially related to the underlying inflammatory milieu; however, given that all patients were receiving canakinumab treatment, they should be interpreted cautiously as exploratory associations requiring confirmation in longitudinal studies.

Association between retinal microcirculation and cardiac function: A cross-sectional study using OCTA.

To describe the first reported case of non-proliferative Duchenne muscular dystrophy-associated retinopathy manifested as bilateral perifoveal ischemia. This observational case report details a 21-year-old male with genetically confirmed Duchenne muscular dystrophy (DMD) who presented with bilateral visual decline. A comprehensive ophthalmic evaluation was performed including best-correct visual acuity (BCVA) assessment, slit-lamp biomicroscopy, dilated fundus examination, full-field and multifocal electroretinography (ERG) in accordance with ISCEV standards and ERGs to sawtooth modulation, structural spectral-domain optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in both eyes. BCVA was 20/40 in both eyes. Anterior segment examination revealed bilateral posterior subcapsular cataracts, while dilated fundoscopic examination was unremarkable. Multifocal ERG demonstrated reduced amplitudes in the central and parafoveal rings, indicating localized retinal dysfunction. OCTA disclosed bilateral, irregular enlargement of the foveal avascular zone consistent with perifoveal ischemia. These vascular abnormalities corresponded to the areas of inner retinal thinning with secondary outer nuclear layer expansion in structural OCT. DMD-associated retinopathy may present with retinal ischemia in the absence of overt fundoscopic abnormalities. Multimodal structural and functional modalities including multifocal ERG, OCT and OCTA may be critical to the early detection of subclinical ischemic changes and for identifying patients at risk of progression to proliferative retinopathy.

Evidence and Consensus Based Guidelines for Imaging in Tubercular Choroiditis. Multimodal imaging in Uveitis (MUV) Taskforce: Report 17.

To develop and validate retinal vascular biomarkers for detecting mild cognitive impairment (MCI) in cerebral small vessel disease (CSVD) using swept-source optical coherence tomography angiography (SS-OCTA). Participants with MCI and normal cognition were prospectively enrolled from two ongoing cohorts (Dream-10 and FRESH-CSVD; NCT06164262 and NCT06431711). All participants underwent SS-OCTA and structural MRI (S-MRI). Individuals with Alzheimer's disease were excluded based on plasma biomarkers. Participants were split into development (January-August 2024) and temporal validation (September 2024-January 2025) cohorts. Feature selection was conducted using least absolute shrinkage and selection operator regression, followed by receiver operating characteristic analyses. A total of 209 participants were included, with 48.8% (102/209) diagnosed with MCI. In the development cohort (n=136), the 3-6 mm macular choriocapillaris perfusion area (CCPA) of the left eye (oculus sinister, OS) showed superior diagnostic accuracy for MCI (AUC=0.906), outperforming S-MRI markers (all p<0.05). Temporal validation confirmed diagnostic accuracy (AUC 0.902; sensitivity 88.6%, specificity 81.3%) with minimal performance drift (ΔAUC 0.002). Adding S-MRI markers did not significantly enhance diagnostic performance (p>0.05). Both 0-3 and 3-6 mm OS macular CCPA were significantly associated with cognitive decline (Mini-Mental State Examination, Montreal Cognitive Assessment and Clinical Dementia Rating Sum of Boxes; all p<0.01), and mediation analyses suggested partial effects through white matter hyperintensity volume and right choroid plexus volume ratio. SS-OCTA-derived macular CCPA, especially in the 3-6 mm OS region, may serve as a promising and non-invasive biomarker for CSVD-related MCI. Further multicentre studies are needed to establish its clinical applicability.

ABSTRACT Purpose To evaluate long-term structural and microvascular alterations in QuantiFERON-positive tubercular serpiginous-like choroiditis (TB-SLC) using swept-source OCT and OCT angiography, and to compare affected eyes with fellow eyes and healthy controls. Methods This retrospective cohort study included 11 patients (16 affected eyes) with QuantiFERON-positive TB-SLC and 20 age- and sex-matched healthy controls (40 eyes). In unilateral cases, fellow eyes served as internal controls. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), and vessel density (VD) of the superficial (SCP), deep (DCP), and choriocapillaris (CC) plexuses, along with foveal avascular zone (FAZ) parameters, were analyzed. Results Mean follow-up duration was 73.6 ± 44.8 months. BCVA improved significantly from 0.68 ± 0.34 to 0.42 ± 0.29 logMAR (p = .004). CMT decreased from 412.6 ± 98.3 µm to 321.4 ± 74.5 µm (p = .001), SFCT from 287.5 ± 72.1 µm to 251.8 ± 65.4 µm (p = .018), and CVI from 0.61 ± 0.05 to 0.58 ± 0.04 (p = .032). Despite clinical improvement, affected eyes showed significantly reduced VD compared with controls, with diffuse sectoral reductions in the CC and DCP (all p ≤ .004), while SCP changes were less pronounced. Deep FAZ area was significantly enlarged in affected eyes (p = .004), whereas superficial FAZ did not differ. In unilateral cases, fellow eyes were comparable to controls, while affected eyes had reduced CC and DCP VD, enlarged deep FAZ, and worse BCVA (all p < .01). Greater baseline inflammatory severity was associated with poorer outcomes. Conclusion In TB-SLC, clinical improvement does not necessarily indicate complete microvascular recovery. Persistent CC and DCP impairment and deep FAZ enlargement suggest long-term chorioretinal remodeling, highlighting OCTA metrics as potential biomarkers of residual vascular damage.

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in developed countries, with prevalence expected to reach nearly 288million by 2040. Accurate classification of AMD is critical for patient care and clinical research, guiding prognosis, therapeutic strategies, and the design of clinical trials. A widely adopted framework, the Beckman classification, stratifies AMD based primarily on color fundus photography (CFP) findings, defining stages from early to late disease. While simple and clinically applicable, such systems do not account for several key phenotypes revealed by advances in multimodal imaging. Such novel phenotypes include reticular pseudodrusen (RPD), acquired vitelliform lesions (AVL), non-exudative macular neovascularization (MNV), incomplete retinal pigment epithelium and outer retina atrophy (iRORA), and non-neovascular exudative fluid. Recent imaging modalities-including optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography (OCTA)-have uncovered features with important prognostic implications that are currently misclassified with respect to AMD. For example, eyes with RPD or AVL in the absence of drusen are currently misclassified as "early AMD" or excluded altogether, despite their high risk of progression. Similarly, the ambiguous status of non-exudative MNV, which carries both protective and harmful potential, highlights the need for greater granularity. The Classification of Atrophy Meetings (CAM) group has also introduced refined OCT-based definitions such as iRORA and cRORA, underscoring early degenerative changes that precede geographic atrophy. Moreover, novel entities like non-neovascular intraretinal or subretinal fluid challenge the assumption that exudation is synonymous with neovascular AMD. This review synthesizes recent evidence highlighting the limitations of current classification systems in light of these advances. Furthermore, we emphasize that intermediate AMD, currently treated as a uniform category, actually encompasses highly heterogeneous phenotypes with distinct risks and trajectories. A more nuanced, imaging-integrated classification system is urgently needed to improve disease staging, identify high-risk eyes, and ensure appropriate patient selection for emerging therapies. Such a framework would not only better reflect the complex natural history of AMD but also facilitate the regulatory shift toward continuous, quantitative endpoints in clinical trials.

PurposeTo characterize the spatiotemporal patterns of vascular remodeling following pterygium excision with amniotic membrane transplantation (AMT) using optical coherence tomography angiography (OCTA).MethodsThis observational study evaluated 43 eyes undergoing AMT. Serial OCTA imaging was performed over a 12-week postoperative period to quantify vascular dynamics in superficial and deep conjunctival layers. Quantitative parameters, including vessel density (VD), vessel length density (VLD), and vessel diameter index (VDI), were analyzed using automated image processing techniques.ResultsEarly assessment at Week 1 showed minimal vascular in-growth. By Week 4, progressive remodeling was evident, primarily driven by deep-layer anastomoses between host tissue and the graft area. By Week 12, a structured vascular network emerged; however, superficial perfusion remained significantly reduced compared to baseline. While deep-layer VD demonstrated substantial recovery, VDI remained statistically stable. Notably, OCTA identified persistent flow voids and heterogeneous perfusion, suggesting irregular host-derived vascular integration beneath the graft.ConclusionPost-AMT healing is mediated predominantly by deep-layer episcleral vascular remodeling. OCTA serves as a sensitive, non-invasive tool for monitoring subclinical vascular integration, offering potential biomarkers for surgical success and early pterygium recurrence.

This study used optical coherence tomography angiography (OCTA) to investigate the early diagnostic value of OCTAparameters for diabetic kidney disease (DKD) in patients with non-proliferative diabetic retinopathy (NPDR). This prospective study enrolled patients with type 2 diabetes mellitus (T2DM) into three groups: those with T2DMwithout retinopathy (group A), those with non-proliferative diabetic retinopathy (NPDR) without DKD (group B), and those with NPDR andDKD (group C). All participants underwent OCTA imaging to measure vessel density (VD) in the superficial capillary plexus (SCP)and deep capillary plexus (DCP), as well as the foveal avascular zone (FAZ) area, perimeter (PERIM), and acircularity index (AI). Pearsonor Spearman correlation analysis was used to explore the relationships between OCTA parameters and renal function indicators, including24-hour urinary microalbumin, urinary albumin-to-creatinine ratio (UACR), and blood urea nitrogen (BUN). Multivariate logistic regressionwas performed to identify independent factors associated with NPDR with DKD. Receiver operating characteristic (ROC) curveswere generated to assess the diagnostic performance of individual and combined OCTA parameters. Significant differences in OCTA parameters and renal function indicators were observed among the three groups. Correlation analysis revealed that SCP-VD and DCP-VD were negatively correlated with 24-hour urinary microalbumin, UACR, and BUN, whereas FAZ area, PERIM, and AI were positively correlated with these renal markers. Multivariate logistic regression identified SCP-VD [oddsratio (OR) = 0.67], DCP-VD (OR = 0.68), PERIM (OR = 1.30), and AI (OR = 1.04) as independent factors associated with NPDR and DKD.Analysis of diagnostic performance showed that among the single parameters, SCP-VD had the best diagnostic value [area under the curve(AUC) = 0.80]. Among the different combination models, the combination of all four parameters demonstrated the highest diagnosticperformance (AUC = 0.94). OCTA parameters (SCP-VD, DCP-VD, PERIM, AI) are closely associated with NPDR and DKD. A combined multiparametermodel demonstrated excellent diagnostic efficacy for early detection. Retinal OCTA parameters may reflect early microvascular alterationsassociated with diabetic kidney disease.

This study aimed to evaluate macular and peripapillary optical coherence tomography angiography (OCTA) parameters in mild and moderate myopic eyes compared with emmetropic controls, utilizing built-in projection artifact removal (PAR) and rigorous magnification correction. This prospective cross-sectional study included 218 eyes (90 emmetropic, 59 mild myopic, and 69 moderate myopic) of adults aged 20-52 years. Macular and optic disc OCTA scans were acquired using the RTVue-XR Avanti system with the built-in 3D-PAR algorithm enabled. Lateral magnification correction was performed post-hoc using the full Littmann-Bennett method ([Formula: see text]), with quadratic scaling applied to area measurements to ensure absolute mathematical precision. Eyes with axial length (AL) > 25.8mm were excluded to minimize segmentation artifacts associated with posterior staphyloma and globe deformation. Deep macular vessel density (VD) demonstrated a significant stepwise reduction across groups: emmetropia (45.92% ± 8.83) → mild myopia (41.44% ± 7.94) → moderate myopia (39.64% ± 10.74) (ANOVA P < 0.001). In contrast, superficial macular VD showed no statistically significant difference between mild myopia and emmetropia, with a significant decline observed only in moderate myopia (P < 0.05). The Foveal Avascular Zone (FAZ) area was significantly enlarged in moderate myopia (0.35 ± 0.12mm², P < 0.001) but remained stable in mild myopia. In multivariable regression, spherical equivalent (SE) was the dominant independent predictor of deep VD reduction (Standardized β = -0.41, P < 0.001). Retinal microvascular attenuation appears to begin early in the deep capillary plexus (even in mild myopia), whereas superficial plexus and FAZ changes are features of more advanced severity. These findings suggest that DCP vessel density is a sensitive population-level indicator of early pathophysiological remodeling, although its current diagnostic utility for individual clinical monitoring is limited by measurement variability relative to the effect size.