Retinal and Choroidal Microvascular Profiles in Professional Handball Players: A Cross-Sectional OCTA Study

The long-term association between professional athletic training and ocular microvascular characteristics remains unclear. This cross-sectional study compared retinal and choroidal optical coherence tomography angiography (OCTA) parameters between 31 male professional handball players with at least five years of training and 30 age-matched sedentary male controls. The right eye of each participant was imaged using a 6 × 6 mm OCTA macular scan (NIDEK RS-3000 Advance). Foveal avascular zone (FAZ) metrics, vessel density (VD), perfusion density (PD), retinal nerve fiber layer (RNFL) thickness, and ganglion cell complex (GCC) thickness were evaluated, and p values were adjusted using the Benjamini-Hochberg false discovery rate procedure. FAZ metrics, RNFL thickness, and GCC thickness did not differ significantly between groups after correction for multiple comparisons. In contrast, all eight retinal and choroidal VD and PD parameters were lower in professional handball players, with adjusted p values ranging from <0.001 to 0.004 and moderate-to-large effect sizes (rank-biserial r = 0.449-0.668). Professional handball participation was associated with lower OCTA-derived retinal and choroidal vascular metrics despite comparable structural OCT parameters. Longitudinal studies are needed to confirm the physiological significance and causal basis of this pattern.