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Applications of Optical Coherence Tomography and Optical Coherence Tomography Angiography in Ophthalmology

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Biomedical Optics".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 5381

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Dr. Daniela Bacherini

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1. Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
2. Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
Interests: retinal imaging; medical retina; OCT; OCT angiography
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Special Issue Information

Dear Colleagues,

This Special Issue entitle “Applications of Optical Coherence Tomography and Optical Coherence Tomography Angiography in Ophthalmology” delves into the revolutionary advancements of Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) in ophthalmic diagnostics. It highlights how these technologies have transformed our ability to non-invasively image and assess ocular structures with unprecedented precision. From detecting early signs of glaucoma and age-related macular degeneration to mapping microvasculature in retinal diseases, OCT/OCTA offers clinicians a powerful tool for accurate diagnosis, enabling timely interventions and improved patient outcomes. This collection of articles explores the latest research, clinical applications, and future directions in this exciting field.

Dr. Daniela Bacherini
Guest Editor

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Keywords

OCT
OCTA
ophthalmology
diagnostics
clinical applications

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Published Papers (5 papers)

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Research

16 pages, 4901 KB

Open AccessArticle

Quantitative Comparison of Two Novel Swept-Source Optical Coherence Tomography Angiography Devices

by Michael Hafner, Daniel J. P. Deschler, Alexander Kufner, Lisa M. Katscher, Siegfried G. Priglinger and Maximilian J. Gerhardt

Diagnostics 2026, 16(5), 801; https://doi.org/10.3390/diagnostics16050801 - 8 Mar 2026

Viewed by 772

Abstract

Background: Swept-source optical coherence tomography angiography (SS-OCTA) enables rapid assessment of retinal microvasculature. However, cross-platform comparability remains limited by device-specific acquisition and image quality characteristics. This study prospectively compared two novel SS-OCTA systems, DREAM (200 kHz) and BMizar (400 kHz). Methods: Fifty eyes from 25 healthy participants underwent 3 mm × 3 mm macular OCTA imaging with both devices in a single session. Images were analysed using OCTAVA to extract foveal avascular zone (FAZ) area, vessel area density (VAD), total vessel length (TVL), node counts, fractal dimension (FD), median vessel length (MVL) in SCP, and mean vessel diameter (MVD) in DCP. Image quality was assessed using FAZ-noise rate, contrast-to-noise ratio (CNR), and FAZ noise-floor standard deviation. Paired comparisons were performed using Wilcoxon signed-rank tests and Cliff’s delta. Results: BMizar acquisition time was shorter than DREAM for the evaluated 3 × 3 mm protocol (median 5.36 s vs. 9.93 s), reflecting differences in A-scan rate and protocol implementation; acquisition time is therefore reported descriptively. In the SCP, DREAM yielded lower VAD (41.9% vs. 48.8%) and fewer nodes (1547 vs. 1879) but exhibited markedly less background noise (noise-floor SD 4.1 vs. 57.9) and substantially higher CNR (16.7 vs. 0.82). DREAM also showed longer MVL (45 vs. 39 µm) and higher FD (1.98 vs. 1.97; δ = 0.90). In the DCP, DREAM demonstrated smaller FAZ areas (0.27 vs. 0.42 mm²), thinner MVD (14 vs. 25 µm), higher node counts (3144 vs. 2301), longer TVL (223.6 vs. 206.2 mm), and higher FD (1.98 vs. 1.97), whereas VAD was higher on BMizar (32.96% for DREAM vs. 49.93% for BMizar). FAZ-noise rates were consistently higher for BMizar in both plexuses. Conclusions: Both devices provide reliable SS-OCTA imaging, but with distinct strengths. DREAM delivers higher vascular continuity and more reliable FAZ and DCP quantification, whereas BMizar achieves faster acquisition at the cost of noise, inflating SCP density and distorting FAZ-based metrics. Awareness of these characteristics is essential to ensure the valid use of OCTA biomarkers in clinical and research applications. Full article

(This article belongs to the Special Issue Applications of Optical Coherence Tomography and Optical Coherence Tomography Angiography in Ophthalmology)

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13 pages, 1034 KB

Open AccessArticle

Association Between Intraocular Pressure Changes and Optic Nerve Head and Macular Perfusion Parameters During Isometric Exercise: OCTA Study

by Nina Krobot Čutura, Dominik-Mate Čutura, Maksimilijan Mrak, Ivanka Petric Vicković and Lana Ružić

Diagnostics 2026, 16(3), 374; https://doi.org/10.3390/diagnostics16030374 - 23 Jan 2026

Viewed by 549

Abstract

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

(This article belongs to the Special Issue Applications of Optical Coherence Tomography and Optical Coherence Tomography Angiography in Ophthalmology)

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12 pages, 899 KB

Open AccessArticle

Evaluation of OCT Angiography Parameters as Biomarkers for Glaucoma Progression

by Konstantina Kancheva, Mladena Radeva, Igor B. Resnick and Zornitsa Zlatarova

Diagnostics 2026, 16(1), 35; https://doi.org/10.3390/diagnostics16010035 - 23 Dec 2025

Cited by 2 | Viewed by 882

Abstract

Background: Optical coherence tomography angiography (OCT-A) provides quantitative assessment of retinal and peripapillary microvasculature and has emerged as a promising tool for glaucoma diagnostics. However, its sensitivity for detecting early glaucomatous progression over short intervals remains uncertain. This study evaluated cross-sectional and short-term longitudinal OCT-A vessel density (VD) metrics in primary open-angle glaucoma (POAG) and explored their relationships with structural (RNFL) and functional (MD) measures. Methods: Sixty eyes (30 POAG, 30 controls) underwent baseline and 6-month examinations including intraocular pressure (IOP), standard automated perimetry (SAP), structural OCT, and OCT-A (RTVue XR Avanti; AngioVue). Parameters analyzed included peripapillary VD (PP-VD), parafoveal VD (PF-VD), foveal avascular zone (FAZ) metrics, FD-300, and RNFL thickness. Between-group comparisons used t-tests or Mann–Whitney U tests. Effect sizes (Cohen’s d), 95% confidence intervals (CI), and ANCOVA models (adjusted for baseline, age, and sex) were included. Longitudinal change was defined as Δ = 6 months − baseline. Pearson correlations evaluated structure–vascular associations. Results: At baseline, POAG eyes showed significantly lower PP-VD, PF-VD, thinner RNFL, and worse MD (all p < 0.001). Strong correlations were observed between RNFL and PP-VD (r ≈ 0.7). Over 6 months, glaucoma eyes showed small but statistically significant reductions in RNFL (Δ = −1.04 µm), MD (Δ = −0.10 dB), and PP-VD (Δ = −0.57%), whereas controls remained stable. However, the absolute OCT-A changes were small and largely within the known range of test–retest variability. ANCOVA demonstrated a significant adjusted group effect only for PP-VD (B = −1.22%, 95% CI −1.53 to −0.90; p < 0.001). Conclusions: OCT-A demonstrated clear cross-sectional differences between POAG and controls and strong structure–vascular associations. However, with only two measurements over a 6-month interval, the study cannot distinguish true glaucomatous progression from physiological or device-related variability. Short-term changes should therefore be interpreted cautiously. PP-VD remains the most robust and consistent OCT-A parameter, but larger, longer, and prospectively powered studies are required to validate OCT-A as a reliable biomarker for progression. Full article

(This article belongs to the Special Issue Applications of Optical Coherence Tomography and Optical Coherence Tomography Angiography in Ophthalmology)

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16 pages, 10545 KB

Open AccessArticle

Macular Microvasculature Is Different in Patients with Primary Sjögren’s Disease Compared to Healthy Controls

by Gyde Tadsen, Nadine Zehrfeld, Laura Hoffmann, Marten Gehlhaar, Bettina Hohberger, Christian Mardin, Torsten Witte, Carsten Framme, Diana Ernst and Katerina Hufendiek

Diagnostics 2025, 15(13), 1701; https://doi.org/10.3390/diagnostics15131701 - 3 Jul 2025

Viewed by 912

Abstract

Background/Objectives: This study investigates the macular microvasculature in a large cohort of primary Sjögren’s disease (SjD) patients using optical coherence tomography angiography (OCTA), focusing on how disease duration, activity, and hydroxychloroquine (HCQ) treatment influence retinal microcirculation. Methods: A total of 106 eyes (53 SjD patients) and 70 eyes (35 age- and gender-matched healthy controls (HCs)) were examined. The vessel area density (VAD, %) and foveal avascular zone (FAZ, mm2) were measured in three retinal layers: Superficial Vascular Plexus (SVP), Intermediate Capillary Plexus (ICP), and Deep Capillary Plexus (DCP), respectively, in three peri-macular circular sectors (c1, c2, c3) each. Results: The VAD was significantly lower in c1 of the DCP in SjD compared to HCs (29.14 ± 7.07 vs. 31.78 ± 9.55, p = 0.038). The FAZ was significantly larger in SjD in both SVP (0.41 ± 0.13 vs. 0.34, 0.11, p < 0.001; Cohen’s |d| = 0.55) and DCP (0.45 ± 0.15 vs. 0.4 ± 0.14, p = 0.014; Cohen’s |d| ± 0.38). Significant correlations were observed between the FAZ size and reductions in the VAD in the SVP and DCP (p = 0.010, Cohen’s |d| = 0.2; p < 0.001, Cohen’s |d| ± 0.26) and across all layers combined (p = 0.019, Cohen’s |d| = −0.18). Conclusions: There was a negative correlation between the VAD in the DCP and disease duration (ρ = −0.28, p = 0.040). No significant correlation was identified between the duration of HCQ intake and the VAD or FAZ. Our findings indicate microvascular alterations in the DCP of SjD, characterized by a reduced VAD and an enlarged FAZ, which may be attributable to inflammatory or arteriosclerotic factors. OCTA may prove to be a valuable tool for the stratification of vascular risk in SjD. Full article

(This article belongs to the Special Issue Applications of Optical Coherence Tomography and Optical Coherence Tomography Angiography in Ophthalmology)

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11 pages, 1402 KB

Open AccessArticle

Comparison of Retinal Microvascular Changes in Axial Spondyloarthritis Using Optical Coherence Tomography Angiography: Anti-TNF vs. NSAID Therapy

by Özlem Karataş, Çisil Erkan Pota, Bülent Akyüz, Yusuf Samet Atlıhan, Kaan Pota, Aslı Çetinkaya Yaprak, Merve Sarı and Serpil Tuna

Diagnostics 2025, 15(5), 597; https://doi.org/10.3390/diagnostics15050597 - 1 Mar 2025

Cited by 2 | Viewed by 1572

Abstract

Objectives: The aim of this study was to investigate retinal and choroidal microvascular changes in patients with axial spondyloarthritis (axSpA) treated with long-term anti-TNF therapy and NSAIDs and in healthy control subjects using optical coherence tomography angiography (SS-OCT-A). Methods: A total of 162 eyes from 81 participants were included: 52 eyes from 26 axSpA patients treated with anti-TNF therapy (≥5 years), 44 eyes from 22 axSpA patients treated with NSAIDs, and 66 eyes from 33 healthy control subjects. SS-OCT-A imaging was used to assess retinal thickness, ganglion cell layer thickness, retinal nerve fiber layer thickness, and the vessel densities of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC). Disease activity was assessed with ASDAS-CRP. Results: Both axSpA subgroups showed a significant expansion of the foveal avascular zone and reduced SCP and DCP densities compared to the controls. The CC vessel density was higher in axSpA patients than in healthy subjects. The anti-TNF group had a lower CC vascular density than the NSAIDs group. The disease duration correlated with a decreased central DCP density and increased paracentral SCP and CC densities. Conclusions: SS-OCT-A revealed subclinical retinal and choroidal changes in axSpA patients, highlighting the impact of chronic inflammation on the retinal vasculature. While anti-TNF therapy effectively controls systemic inflammation, it cannot completely prevent microvascular changes. Further studies are needed to assess the clinical relevance of these results. Full article

(This article belongs to the Special Issue Applications of Optical Coherence Tomography and Optical Coherence Tomography Angiography in Ophthalmology)

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