Search Results (88)

Background: Attention deficit hyperactivity disorder (ADHD) lacks objective biomarkers that may complement clinical diagnosis. Optical coherence tomography angiography (OCTA) enables non-invasive quantitative assessment of retinal microvasculature and has emerged as a potential tool to explore neurovascular features associated with neurodevelopmental disorders. The aim of this study was to comparatively evaluate macular and peripapillary OCTA parameters in individuals with ADHD and neurotypical controls. Methods: This comparative case–control study involved 200 eyes (100 from 50 patients with ADHD and 100 from 50 neurotypical controls) belonging to the same well-characterized cohort previously evaluated using structural optical coherence tomography (OCT). Macular and peripapillary OCTA scans were obtained, and quantitative parameters related to vessel density, perfusion density, and peripapillary flow metrics of the superficial retinal capillary plexus were analyzed separately for right and left eyes. Group comparisons were performed using independent-samples t-tests and analysis of covariance adjusted for age, sex, and axial length, with correction for multiple comparisons. Results: After adjustment for age, sex, and axial length, no OCTA parameter showed statistically significant between-group differences after correction for multiple comparisons. Across parameters, mean differences were small and did not provide statistical evidence of an effect under the prespecified analytical framework. Conclusions: Superficial OCTA-derived microvascular parameters did not demonstrate robust between-group differences in ADHD in this cohort. These results suggest that when restricted to the superficial capillary plexus, OCTA metrics are unlikely to serve as standalone biomarkers for ADHD. Full article

Background/Objectives: This study aimed to evaluate macular choroidal blood flow dynamics and structural alterations in children with hyperopic anisometropic amblyopia and compare these findings with those of the fellow eyes. Methods: This retrospective observational study included 36 eyes from 18 children (mean age: 4.9 years) with unilateral hyperopic anisometropic amblyopia. Central choroidal thickness (CCT) was measured using enhanced depth imaging optical coherence tomography. Macular choroidal hemodynamics were assessed using laser speckle flowgraphy. Mean blur rate (MBR) was used as an index of blood flow, whereas beat strength (BS) was used as a measure of pulsatility. Ocular perfusion pressure (OPP) was also calculated. All parameters were compared between amblyopic and fellow eyes. Results: Amblyopic eyes demonstrated significantly greater CCT compared with fellow eyes (407.6 ± 84.9 µm vs. 326.4 ± 79.1 µm). Conversely, macular MBR was significantly lower in amblyopic eyes (9.28 ± 3.60 AU vs. 10.94 ± 4.68 AU), as was BS (5.73 ± 3.07 AU vs. 7.28 ± 3.59 AU). No significant differences were observed in central retinal thickness or OPP between amblyopic and fellow eyes. In amblyopic eyes, CCT was not significantly correlated with macular MBR or BS. Conclusions: Amblyopic eyes exhibited significant central choroidal thickening accompanied by reduced macular blood flow and pulsatility. These findings suggest that localized macular hemodynamic dysregulation may contribute to the pathophysiology of hyperopic anisometropic amblyopia. Full article

Background/Objectives: End-stage renal disease (ESRD) is characterized by profound and progressive microvascular dysfunction that contributes significantly to systemic morbidity. Because the retinal and renal microcirculations share structural and physiological similarities, optical coherence tomography (OCT) and OCT angiography (OCTA) have emerged as promising tools for detecting ocular microvascular changes that may parallel systemic vascular injury. This systematic review aimed to consolidate evidence on chronic retinal and choroidal alterations in ESRD as assessed by OCT and OCTA. Methods: A systematic search of PubMed/MEDLINE (inception–June 2025) was performed using combinations of terms related to OCT, OCTA, ESRD, and hemodialysis. After removing duplicates and screening titles, abstracts, and full texts, we included clinical studies involving adults with ESRD or undergoing dialysis that reported chronic or baseline OCT/OCTA findings. Non-English publications, editorials, conference abstracts, case reports, and studies limited to acute pre-/post-dialysis changes were excluded. Seventeen studies met eligibility criteria. Acute findings were summarized narratively only when no chronic data existed for a specific parameter but were not incorporated into the primary synthesis. Results: Across eligible studies, chronic structural and perfusion abnormalities were consistently reported, including thinning of the retinal nerve fiber and ganglion cell layers, reduced macular and peripapillary vascular densities, enlarged foveal avascular zones, and decreased choroidal thickness. These alterations aligned with markers of disease severity and systemic microvascular burden. Conclusions: Retinal imaging reveals reproducible chronic microvascular changes in ESRD and may serve as an accessible adjunct for systemic vascular assessment. We highlight the potential significance of retinal vascular screening in this population and the need for more standardized imaging protocols to support the effective integration of retinal biomarkers into CKD diagnostic and monitoring strategies. Full article

Phacoemulsification is performed within a highly dynamic intraocular environment, in which fluid exchange, pressure regulation, and tissue biomechanics interact continuously. Although modern cataract surgery is considered safe and efficient, disruption of this delicate intraoperative microenvironment remains a major source of complications. Among fluidics-related events, post-occlusion break surge represents one of the most critical destabilizing factors of the anterior chamber. A surge occurs when the sudden release of an occluded aspiration port generates an abrupt pressure–volume imbalance that cannot be immediately compensated by infusion, leading to a transient collapse of the intraocular environment. This narrative review integrates current experimental and clinical evidence on the pathophysiology, quantification, and technological control of surge, framing it as a model of environmentally driven intraoperative stress. The evolution of phacoemulsification fluidics, from gravity-based systems to active, adaptive, and predictive platforms, is analyzed in relation to their ability to preserve a stable and physiologic intraocular environment. Comparative data from contemporary devices are reviewed, highlighting differences in surge volume, recovery time, and pressure restitution. Special emphasis is placed on the impact of surge on the microenvironments of both the anterior and posterior segments, including endothelial stress, capsular instability, vitreoretinal traction, and macular perfusion. Emerging strategies such as handpiece-integrated pressure sensors, predictive fluidics algorithms, intraoperative imaging, and artificial intelligence are reshaping environmental control during surgery. Despite substantial technological progress, the complete elimination of surge remains an unmet need. Continued innovation, standardized biomechanical models, and robust clinical validation will be essential to further protect the intraoperative intraocular environment and improve long-term visual outcomes. Full article

Background/Objectives: Optical coherence tomography angiography (OCTA) is a non-invasive imaging method that enables accurate in vivo visualisation and quantification of the macular and optic nerve head microvasculature, providing an indirect assessment of local retinal perfusion. This study aimed to evaluate the changes in OCTA perfusion parameters of macula and optic nerve head in healthy individuals following different isometric exercises and to determine their association with intraocular pressure alterations. Methods: Each subject performed four isometric exercises: elbow plank, reverse plank, right-side plank, and wall sit. Measurements of intraocular pressure, systemic blood pressure, heart rate, and OCT angiography of macula and optic nerve head were conducted before each exercise, immediately after its completion, and after a five-minute rest period. Intraocular pressure was measured using a Perkins applanation tonometer, and systemic blood pressure and heart rate were recorded using an automated sphygmomanometer. The relationship between changes in intraocular pressure and OCTA perfusion parameters was analysed. Results: A total of 12 eyes of 12 healthy subjects were included in the study, with a mean age of 28.67 ± 2.39 years. An immediate reduction in optic nerve head vessel density was observed after each exercise (elbow plank: p = 0.012; wall sit: p = 0.009; reverse plank: p < 0.001; right-side plank: p < 0.001), with a sustained decrease during the rest period following right-side plank. No significant changes in vessel density were observed in the macular region. Heart rate and systemic blood pressure increased after each exercise, while intraocular pressure increased following all exercises except the wall sit. Changes in intraocular pressure were significantly negatively associated with changes in optic nerve head vessel density in the post-rest period following elbow plank (inside disc sector: b = −1.153, p = 0.02, peripapillary sector: b = −0.369, p = 0.009) and reverse plank (whole image sector: b = −0.589, p = 0.031). Conclusions: The performance of isometric exercises induced an acute reduction in optic nerve head vessel density, and a significant association with intraocular pressure changes was observed. OCTA represents a promising research tool not only for the assessment of retinal microcirculation but also in the field of sports medicine. Full article

Background/Objectives: Vitamin B₁₂ deficiency is increasingly recognized as a contributor in both vascular and neurodegenerative aging-related disorders. Its deficiency disrupts one-carbon metabolism, leading to impaired homocysteine (Hcy) cycling. Elevated Hcy is a well-established risk factor for vascular dysfunction. Previously, we established that elevated Hcy contributes to aging retinal diseases and plays a central role in blood retinal barrier (BRB) dysfunction. Building on this foundation, the present study examines how B-vitamin deficiency disrupts one-carbon metabolism and whether restoring these vitamins can serve as a preventive or therapeutic strategy. Since B-vitamins (B₆, B₉, and B₁₂) are crucial cofactors in the metabolism of Hcy, we investigated how dietary changes in these vitamins affect serum Hcy levels and retinal vascular integrity in mice. Methods: C57BL/6- Wild-type (WT) and cbs^+/− mice (Cystathionine Beta-Synthase heterozygotes, common mouse model for elevated Hcy) were fed specially formulated diets, which contained different levels of B-vitamins (normal, deficient (B-Vit (−)) or enriched (B-Vit (+)). Initially, two groups of mice were placed on either a normal or a deficient diet. After 12–16 weeks, the success of the diet regimes was confirmed by observing serum B₁₂ deficiency in the B-Vit (−) group, along with elevated Hcy levels. Subsequently, a subgroup of the B-Vit (−) mice was switched to an enriched diet. The BRB integrity was evaluated in living mice using fluorescein angiography (FA), optical coherence tomography (OCT), and in the perfused mice retinas with Western blot analysis of leaked retinal albumin and tight junction proteins (occludin and ZO-1) levels. Results: The B-vitamin deficiency caused significant drop in serum vitamin B₁₂ and an increase in plasma Hcy, leading to vascular leakage, altered retinal thickness, choroidal neovascular changes, increased retinal albumin leak, and decreased tight junction protein expression, indicating BRB disruption, which was restored with B-vitamin supplementation. Conclusions: a long-term deficiency of vitamins B₆, B₉, and B₁₂ can lead to disruptions in the BRB. However, supplementation with these B-vitamins has the potential to reverse these effects and help maintain the integrity of BRB. This under-score the significance of one-carbon metabolism for retinal health and suggests that ensuring adequate levels of B-vitamins may aid in preventing aging retinal diseases with BRB disruption such as diabetic retinopathy and age-related macular degeneration. Full article

Objectives: This study aimed to investigate the association between optical coherence tomography angiography (OCTA) parameters and cardiovascular (CV) risk scores in individuals with type 1 diabetes (T1D). Methods: A cross-sectional analysis of a large-scale prospective OCTA trial cohort (ClinicalTrials.gov NCT03422965) was performed. Demographic, systemic, and ocular data—including OCTA imaging—were collected. T1D participants were stratified into three CV risk categories: moderate (MR), high (HR), and very high risk (VHR). Individualized predictions for fatal and non-fatal CV events at 5 and 10 years were calculated using the STENO T1 Risk Engine calculator. Results: A total of 501 individuals (1 eye/patient; 397 T1D, 104 controls) were included. Subjects with MR (n = 37), HR (n = 152) and VHR (n = 208) exhibited significantly reduced vessel density (VD) (20.9 ± 1.3 vs. 20.2 ± 1.6 vs. 19.3 ± 1.8 mm⁻¹, p < 0.05), perfusion density (PD) (0.37 ± 0.02 vs. 0.36 ± 0.02 vs. 0.35 ± 0.02%, p < 0.05) and foveal avascular zone circularity (0.69 ± 0.06 vs. 0.65 ± 0.07 vs. 0.63 ± 0.09, p < 0.05). Statistically significant negative correlations were observed between CV risk and OCTA parameters including VD, PD, and retinal nerve fiber layer thickness, while central macular thickness (CMT) showed a positive correlation (p < 0.05). Notably, CMT was significantly associated with 5-year CV risk. Conclusions: OCTA-derived metrics, particularly reduced retinal VD and PD, are associated with elevated CV risk scores in T1D patients. These findings suggest that OCTA may serve as a valuable non-invasive tool for identifying individuals with increased CV risk scores. Full article

Vitamin D deficiency is increasingly recognized as a systemic factor influencing retinal health through inflammatory, neuroprotective, and vasculotropic pathways. Evidence regarding early retinal alterations in otherwise healthy adults remains limited. This cross-sectional study evaluated 120 eyes from 60 healthy adults stratified by serum 25(OH)D levels into <30 ng/mL (n = 60) and ≥30 ng/mL (n = 60). All subjects underwent optical coherence tomography (OCT), OCT angiography (OCTA), visual field testing, and contrast sensitivity assessment. Central macular thickness (CMT), ganglion cell complex (GCC) thickness, and perfusion density in the superficial and deep capillary plexuses (SCP, DCP) were compared between groups. Vitamin-D-insufficient eyes showed significantly reduced CMT (267.66 ± 13.31 µm vs. 274.69 ± 14.96 µm; p = 0.035). GCC thinning was significant only in the inner inferior nasal sector (70.7 ± 13.14 µm vs. 76.45 ± 12.12 µm; p = 0.030), whereas other GCC sectors were comparable between groups. Perfusion density was lower in the DCP across whole, inner, and outer regions (all p < 0.001) and in the SCP inner (p = 0.027) and outer (p = 0.009) regions, while whole SCP did not differ (p = 0.065). FAZ area was numerically larger in vitamin-D-insufficient eyes but was not statistically different (p = 0.168). Functionally, retinal sensitivity decline was greater in vitamin-D-insufficient eyes (−2.89 ± 1.29 dB vs. −2.16 ± 1.04 dB; p = 0.003), and mean central sensitivity was lower (p = 0.010), whereas contrast sensitivity did not differ between groups. Serum vitamin D levels < 30 ng/mL are associated with early, subclinical, structural and microvascular retinal alterations in healthy adults, supporting a potential role of hypovitaminosis D as a modifier of retinal integrity. Full article

Purpose: Current pediatric ophthalmology practice relies on adult reference values for optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) interpretation due to limited age-appropriate normative data, potentially leading to diagnostic misclassification. Methods: We conducted a prospective, cross-sectional study comparing OCT and OCT-A parameters between 37 healthy Caucasian children (1–17 years) and 28 adults (19–65 years) using identical Zeiss CIRRUS protocols. Parameters included peripapillary retinal nerve fiber layer (RNFL), macular thickness, ganglion cell-inner plexiform layer (GCIPL), optic nerve head (ONH) perfusion, and macular vascular density. Results: Children exhibited significantly thinner parafoveal macular thickness compared to adults (251.67 ± 21.32 vs. 270.36 ± 17.02 μm; p < 0.001) while RNFL thickness remained comparable. OCT-A demonstrated higher ONH perfusion in children across multiple sectors (p < 0.001). Within the pediatric cohort, younger children (1–9 years) showed higher macular vessel and perfusion density than older children (10–17 years). All pediatric scans achieved excellent image quality with no exclusions. Conclusions: Clinically significant age-related differences in retinal structure and vasculature necessitate pediatric-specific reference ranges. The demonstrated technical feasibility supports routine OCT/OCT-A implementation in pediatric practice with age-appropriate interpretation guidelines. Full article

Background: Laser Speckle Flowgraphy (LSFG) is a non-invasive imaging technology that quantitatively evaluates retinal and choroidal blood flow by analyzing speckle patterns generated by laser light scattering. This systematic review summarizes the application of LSFG in two major degenerative retinal diseases: age-related macular degeneration (AMD) and diabetic retinopathy (DR). Methods: A comprehensive literature search (2010–2025) was conducted in PubMed, Cochrane Library and EMBASE according to PRISMA guidelines. Twenty-three studies including a total of 974 eyes (191 AMD, 783 DR) were analyzed. Results: In AMD, LSFG detected baseline reductions in choroidal and retinal perfusion in non-exudative disease, often extending beyond atrophic regions. Anti-VEGF injections produced acute reductions in MBR, particularly with brolucizumab, with partial recovery over time; drug-specific differences suggest a potential impact on geographic atrophy progression. In DR, LSFG revealed early microvascular dysfunction even in asymptomatic eyes. Retinal and choroidal MBR and blowout score correlated with HbA1c, DR severity, and inflammatory mediators. Intravitreal anti-VEGF therapy consistently reduced retinal and choroidal MBR and RFV, while conventional panretinal photocoagulation decreased choroidal flow and vascular caliber more robustly than patterned laser, reflecting oxygenation-driven VEGF modulation. Low baseline MBR predicted higher central macular thickness and reduced therapeutic response in diabetic macular edema. Conclusions: LSFG provides reproducible, rapid, and non-invasive quantitative insights into ocular hemodynamics across degenerative retinal diseases. Its integration into multimodal imaging may facilitate early diagnosis, support personalized management, and assist in the prognostic assessment of retinal and choroidal vascular disorders. Full article

Objectives: To assess retinal microvascular changes in patients with Grade II and III obesity before and after bariatric surgery using Optical Coherence Tomography Angiography (OCTA), and to compare these metrics with age- and sex-matched healthy controls. Methods: Prospective, consecutive, longitudinal cohort study with a 12-month follow-up. Grade II and III obese patients scheduled for bariatric surgery underwent comprehensive ophthalmic examinations, including OCTA imaging, prior to the surgery and postoperatively at 1 month, 6 months, and 12 months post-surgery. Results: A total of 43 eyes from 43 patients with obesity (one eye per patient) were included at baseline. At 12 months post-surgery, there was a significant increase in vessel density (VD) (16.70 vs. 17.68; p < 0.01) and perfusion density (PD) (0.406 vs. 0.433; p < 0.01), reaching values comparable to those of the control group (17.73 and 0.434, respectively). Significant reductions were also observed in body mass index (BMI) (43.74 vs. 29.53; p < 0.01), body weight (122.44 kg vs. 81.90 kg; p < 0.01), and intraocular pressure (IOP) (15.72 mmHg vs. 14.16 mmHg; p < 0.01). Conclusions: This study demonstrates a compelling association between obesity and retinal microvascular impairment, highlighting the efficacy of bariatric surgery not only in achieving substantial weight loss but also in improving the retinal perfusion of these patients, achieving metrics at 12 months comparable to age- and sex-matched healthy controls at baseline. These findings raise the hypothesis of the potential utility of OCTA as a monitoring tool for tracking the microvascular status in patients with obesity undergoing bariatric surgery in a longitudinal manner. Full article

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as cornerstone therapies for type 2 diabetes mellitus and obesity, offering significant cardiovascular and renal protection. However, recent evidence has sparked interest and concern regarding their potential ocular effects. This review critically synthesizes current data on the impact of GLP-1RAs on diabetic retinopathy (DR), nonarteritic anterior ischemic optic neuropathy (NAION), age-related macular degeneration (AMD), and glaucoma or ocular hypertension. While preclinical studies suggest GLP-1RAs exert anti-inflammatory and neuroprotective effects in retinal tissues, clinical data remain mixed. Several large observational studies suggest a protective role against DR and glaucoma, while others raise safety concerns, particularly regarding semaglutide and NAION. Evidence on AMD is conflicting, with signals of both benefit and risk. We also discuss plausible pathophysiological mechanisms and the relevance of metabolic modulation on retinal perfusion. Overall, while GLP-1RAs hold promise for ocular protection in some contexts, vigilance is warranted, especially in patients with pre-existing eye disease. Further ophthalmology-focused prospective trials are essential to clarify long-term safety and guide clinical decision making. Full article

Background: Rhegmatogenous retinal detachment (RRD), the most common type of retinal detachment, requires prompt surgery to reattach the retina and avoid permanent vision loss. While surgical treatment is adapted to each individual case, one frequent option is pars plana vitrectomy (PPV) with silicone oil (SO) tamponade. Despite achieving anatomical success (complete retinal attachment), concerns persist regarding potential microvascular alterations in the retina and choroid, with a negative impact on visual function. Optical coherence tomography angiography (OCTA) allows detailed, in-depth imaging of retinal and choroidal circulation, whereas microperimetry makes it possible to accurately assess macular function. This review aims to strengthen the existing evidence on vascular and functional alterations at the macular level after SO tamponade in cases of RRD. Methods: A narrative review was conducted using a structured approach, utilizing a PubMed search from January 2000 up to April 2025. Twenty-three studies on OCTA and microperimetry after SO tamponade for RRD were included. Data on vessel densities, choroidal vascular index (CVI), foveal avascular zone (FAZ) size, and retinal sensitivity were extracted and qualitatively analyzed. Results: Studies consistently reported a reduction in the vessel density within the superficial capillary plexus (SCP) under SO tamponade, with partial but incomplete reperfusion post-removal. Choroidal perfusion and CVI were also decreased, exhibiting a negative correlation with the duration of SO tamponade. Microperimetry demonstrated significant reductions in retinal sensitivity (~5–10 dB) during SO tamponade, which modestly improved (~1–2 dB) following removal but generally remaining below normal levels. Conclusions: SO tamponade causes substantial retinal and choroidal vascular impairment and measurable macular dysfunction, even after anatomical reattachment of the retina. It is recommended to perform early SO removal (~3–4 months) and implement routine monitoring by OCTA and microperimetry with the aim of optimizing patient outcomes. Future research should focus on investigating protective strategies and enhancing visual rehabilitation following RRD repair. Full article

Background and Clinical Significance: Purtscher-like retinopathy is a rare occlusive microangiopathy that causes sudden vision loss of varying severity. It presents with diverse retinal findings, such as cotton-wool spots, haemorrhages, and optic disc and macular edema, among others. A key characteristic is the absence of trauma. This condition has been observed in patients with acute pancreatitis, renal failure, preeclampsia, HELLP syndrome, childbirth, and other systemic disorders. Case Presentation: A 35-year-old male presented with complaints of seeing spots in front of both eyes, with a duration of ten days following the initiation of treatment for acute alcoholic pancreatitis. On examination, best-corrected visual acuity (BCVA) in both eyes was 5/6. Fundus examination revealed multiple cotton-wool spots and haemorrhages located in the posterior pole and around the optic disc, more pronounced in the left eye, where the optic disc had blurred margins and the macular reflex was absent. Perimetry showed paracentral scotomas, and optical coherence tomography (OCT) revealed thickening and disruption of the inner retinal layers in the papillomacular region of both eyes. Fundus fluorescein angiography demonstrated adequate perfusion of the vascular network, with hypofluorescent areas in the arteriovenous phase, peripapillary and in the papillomacular zone, due to masking by cotton-wool spots and haemorrhages. Treatment included systemic antiplatelet agents, anticoagulants, and vitamins, along with topical non-steroidal anti-inflammatory drugs. Two months after the initial presentation visual acuity improved to 6/6 in both eyes. Follow-up OCT scans showed atrophy of the inner retinal layers corresponding to the previous cotton-wool spot and the areas of reduced light sensitivity on perimetry had decreased in size. Conclusions: Acute pancreatitis is the most common systemic condition associated with the development of Purtscher-like retinopathy. Timely diagnosis and management of the underlying systemic disease are essential for preventing ocular complications. Ophthalmological evaluation is necessary in patients with acute pancreatitis who present with visual symptoms in order to detect this often-overlooked rare condition. Full article

Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, EMBASE, Google Scholar, and the Cochrane Database up to April 2025. The search terms included “Optical coherence tomography angiography,” “OCTA,” “Retinal arterial occlusion,” “Central retinal artery occlusion,” and “Branch retinal artery occlusion.” Studies were included if they evaluated the role of OCTA in diagnosing or assessing acute RAO. Case reports, conference abstracts, and non-English articles were excluded. Two reviewers independently conducted the study selection and data extraction. The methodological quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Results: The initial search yielded 457 articles, from which 10 studies were ultimately included in the final analysis after a rigorous screening process excluding duplicates, non-English publications, and ineligible articles based on title, abstract, or full-text review. The included studies consistently demonstrated that OCTA is a valuable, noninvasive modality for evaluating microvascular changes in RAO. Key OCTA findings in acute RAO include significant perfusion deficits and reduced vessel density in both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Several studies noted more pronounced involvement of the SCP compared to the DCP. OCTA parameters, such as vessel density in the macular region, have been found to correlate with visual acuity, suggesting a prognostic value. While findings regarding the foveal avascular zone (FAZ) were mixed, the peripapillary area frequently showed reduced vessel density. Conclusion: Acute RAO is an ocular emergency that causes microvascular ischemic changes detectable by OCTA. This review establishes OCTA as a significant noninvasive tool for diagnosing, monitoring, and prognosticating RAO. It effectively visualizes perfusion deficits that correlate with clinical outcomes. However, limitations such as susceptibility to motion artifacts, segmentation errors, and the lack of standardized normative data must be considered. Future standardization of OCTA protocols and analysis is essential to enhance its clinical application in managing RAO. Full article