Optical coherence tomography angiography in pediatric and adult populations: A comprehensive review

Optical coherence tomography angiography (OCT-A) is a non-invasive retinal imaging tool with expanding clinical and research applications, including potential uses as a biomarker for systemic diseases. The influence of age on OCT-A parameters, however, remains incompletely understood. To address this, we conducted a comprehensive review across seven databases, screening 271 full-text articles, of which 156 met inclusion criteria. Extracted data included participant demographics, study design, OCT-A device type, measured parameters, and outcomes across retinal layers in the macula and optic nerve head. Normative OCT-A values for pediatric and older adult populations were also reviewed. Evidence consistently demonstrated an age-related decline in macular vessel density among adults, even after accounting for signal strength. In contrast, pediatric studies showed variable associations between age and vascular parameters. Across all populations, foveal avascular zone size remained largely unaffected by age. These findings highlight the importance of considering age when interpreting OCT-A metrics in both clinical and research settings.