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

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.