Retinal microvasculature and macular–choroidal thickness in oral contraceptive users: an OCTA and OCT comparative study

Potential retinal vascular changes associated with hormonal contraceptive use remain insufficiently characterized in the literature. Optical coherence tomography angiography (OCTA) enables a noninvasive and highly detailed evaluation of retinal microvasculature. This study aimed to assess the superficial and deep retinal capillary plexuses, and macular and choroidal thickness in women using combined oral contraceptives (COC) or progestogen-only contraceptives (POC) compared with women who had never used hormonal contraceptives. The potential influence of the duration of use was also investigated. A cross-sectional analysis was conducted in 120 healthy women aged 20–40 years, equally distributed into the COC, POC, and control groups. OCTA was used to measure foveal avascular zone (FAZ) parameters and vessel densities of the superficial and deep plexuses in a 3 × 3 mm scan. Macular and choroidal thickness were obtained using spectral-domain optical coherence tomography. One randomly selected eye of each participant was analyzed. Intergroup comparisons were performed using analysis of variance (ANOVA) or Kruskal–Wallis test, with appropriate post-hoc analyses; significance was set at 5%. No significant differences were observed among the groups in FAZ parameters, macular thickness, or choroidal thickness. A small but statistically significant reduction in vessel density of the nasal parafoveal sector of the superficial capillary plexus was found in the POC subgroup with less than two years of use compared with controls (P = 0.033; post-hoc P = 0.049). No other significant differences were detected in the superficial or deep plexuses. Hormonal contraceptive use was not associated with significant alterations in FAZ parameters, macular or choroidal thickness, or overall retinal vessel density. A slight reduction in nasal parafoveal vessel density was observed in women with POC use for less than 2 years compared with controls, although the clinical significance of this finding remains uncertain. These results suggest that retinal vascular changes associated with hormonal contraceptives are minimal, underscoring the need for longitudinal studies with larger samples to confirm these observations.