COMPARISON OF ULTRAHIGH-SPEED 250 kHz OCTA WITH HIGH-SPEED 125 kHz MODE USING HEIDELBERG SPECTRALIS SHIFT: A Paired-Eye Analysis.

Abstract

Optical coherence tomography angiography is widely used to detect choroidal neovascularization in retinal diseases, but acquiring high-density raster scans can prolong acquisition time and increase motion artifacts due to patient fatigue. This study evaluates whether the 250 kHz ultrahigh-speed mode (3× faster than baseline) reduces scan time and motion artifacts while maintaining image quality compared with the FDA-approved 125 kHz mode. Fifty-eight eyes underwent 10°×10° fovea-centered optical coherence tomography angiography imaging using both modes. In 38 choroidal neovascularization eyes, AngioTool was used to analyze vascular metrics. In 20 nonchoroidal neovascularization eyes, superficial foveal avascular zone area was measured using ImageJ. Two masked retina specialists graded paired images for image quality, motion artifacts, and clinical diagnosis. Acquisition time was recorded. The 250 kHz mode reduced acquisition time by 43% (17.5 ± 9.0 seconds vs. 33.6 ± 20.7 seconds, P < 0.00001). Image quality and motion artifacts favored the 250 kHz mode. Clinical diagnosis was rated similarly across modes. Quantitative metrics, including vessel area, junctions, lacunarity, and foveal avascular zone area, showed no significant differences (all P > 0.1). This is the first intraindividual comparison of Heidelberg's 250 kHz and 125 kHz optical coherence tomography angiography modes. The findings demonstrate that ultrahigh-speed scanning can enhance efficiency and image quality without compromising diagnostic or quantitative utility, highlighting its potential clinical impact pending Food and Drug Administration approval.