Optical coherence tomography angiography of the macular retina and choroid in glaucoma: a narrative review.

Glaucoma is a progressive optic neuropathy characterized by retinal ganglion cell degeneration, structural remodeling of the retina and choroid, and irreversible visual field loss. Increasing evidence indicates that microvascular dysfunction plays a crucial role in its onset and progression. Optical coherence tomography angiography (OCTA), as a noninvasive, high-resolution imaging technique, enables quantitative visualization of retinal and choroidal microcirculation, providing new insights into the structural-vascular-functional relationships in glaucoma. This narrative review summarizes recent advances in the use of OCTA for evaluating macular retinal and choroidal changes in glaucoma, emphasizing its potential in early diagnosis, disease monitoring, and postoperative assessment. Moreover, retinal OCTA vessel-density parameters are closely associated with visual field impairment, whereas the prognostic value of many choroidal metrics remains less well established. With continuous technological innovation and deeper understanding of ocular hemodynamics, OCTA is expected to play an increasingly important role in the early detection and comprehensive management of glaucoma.