Age-Related Differences in Optical Coherence Tomography and Optical Coherence Tomography Angiography Parameters Between Healthy Children and Adults: A Comparative Analysis in a Caucasian Population

<b>Purpose</b>: Current pediatric ophthalmology practice relies on adult reference values for optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) interpretation due to limited age-appropriate normative data, potentially leading to diagnostic misclassification. <b>Methods</b>: We conducted a prospective, cross-sectional study comparing OCT and OCT-A parameters between 37 healthy Caucasian children (1-17 years) and 28 adults (19-65 years) using identical Zeiss CIRRUS protocols. Parameters included peripapillary retinal nerve fiber layer (RNFL), macular thickness, ganglion cell-inner plexiform layer (GCIPL), optic nerve head (ONH) perfusion, and macular vascular density. <b>Results</b>: Children exhibited significantly thinner parafoveal macular thickness compared to adults (251.67 ± 21.32 vs. 270.36 ± 17.02 μm; <i>p</i> < 0.001) while RNFL thickness remained comparable. OCT-A demonstrated higher ONH perfusion in children across multiple sectors (<i>p</i> < 0.001). Within the pediatric cohort, younger children (1-9 years) showed higher macular vessel and perfusion density than older children (10-17 years). All pediatric scans achieved excellent image quality with no exclusions. <b>Conclusions</b>: Clinically significant age-related differences in retinal structure and vasculature necessitate pediatric-specific reference ranges. The demonstrated technical feasibility supports routine OCT/OCT-A implementation in pediatric practice with age-appropriate interpretation guidelines.