Optical coherence tomography angiography in retinal vascular disease: transformative tool or expensive gimmick?

Optical coherence tomography angiography (OCTA) has rapidly evolved from an experimental imaging technique into a routine component of many retina practices. By providing noninvasive, depth-resolved visualization of retinal and choroidal vasculature without dye injection, OCTA promises safer, faster, and more detailed assessment of retinal vascular disease than fluorescein angiography. However, there is still debate about its clinical applicability and its role in everyday ophthalmology practice, which we review in this article.

Over the past decade, OCTA has been extensively applied to diabetic retinopathy, retinal vein occlusion, sickle cell retinopathy, and other ischemic disorders, generating a growing body of literature linking OCTA-derived metrics to disease severity and visual outcomes. Despite this enthusiasm, significant limitations remain, including susceptibility to artifacts, restricted field of view, inability to demonstrate vascular leakage, and uncertain impact on management decisions.

We critically evaluate the current role of OCTA in retinal vascular disease by reviewing recently published literature. This review examines OCTA's technical foundations, clinical applications, strengths, limitations, and future directions. We argue that OCTA is neither a replacement for conventional angiography nor a mere technological novelty, but rather a powerful complementary imaging modality whose value depends on appropriate interpretation and thoughtful clinical integration.