Normative Optical Coherence Tomography Angiography Metrics of Macular Vessel Density and Foveal Avascular Zone in Healthy Children

<b>Background</b>: Optical coherence tomography angiography (OCTA) enables non-invasive, high-resolution visualization of the retinal microvasculature and is increasingly utilized in pediatric ophthalmology. However, its clinical application in children is limited by the absence of age-specific normative data. <b>Methods</b>: In this cross-sectional study, macular vessel density (VD) and foveal avascular zone (FAZ) area were assessed in 118 healthy Caucasian children aged 4 to 17 years. OCTA scans were obtained using the OCT Topcon Triton^® device with 3 × 3 mm and 6 × 6 mm macular cubes. Vascular metrics from the superficial (SCP) and deep capillary plexuses (DCP) were analyzed in relation to demographic, refractive, biometric, and structural OCT parameters. Correlation and multivariate linear regression analyses were performed to evaluate associations. <b>Results</b>: Age-stratified reference percentiles for macular VD and FAZ area in SCP and DCP are presented for 118 children. Key associations included: (1) Increased macular thickness correlated with higher VD in the fovea and inner ring (SCP and DCP, all <i>p</i> < 0.05); (2) Thicker maculas were associated with smaller FAZ areas (SCP: r = -0.72, DCP: r = -0.58, both <i>p</i> < 0.001); (3) Older age was linked to reduced VD in the inner macular ring and smaller FAZ area (SCP and DCP, all <i>p</i> < 0.001); and (4) longer axial length correlated with lower central VD (SCP: r = -0.27, DCP: r = -0.37, both <i>p</i> < 0.05). No significant sex-based differences were observed. <b>Conclusions</b>: This study provides normative OCTA data for macular VD and FAZ area in healthy Caucasian children and identifies key associations with ocular parameters. These findings support improved diagnostic accuracy and clinical decision-making in pediatric retinal evaluation.