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Purpose: We investigate macular perfusion and the systemic and ocular associations in a population-based setting.

Methods: In this cross-sectional study, 2018 adults residing in Hong Kong underwent detailed ophthalmic examinations after consenting to participate. Macular perfusion was measured with optical coherence tomography angiography (OCTA) using the split-spectrum amplitude decorrelation angiography algorithm. The parafoveal flow index and vessel area density were quantified using automated custom-built software.

Results: Of the 2018 participants, the OCTA measurements were available for 1940, and 1631 (84.1%) had good quality scans. The right eyes of these 1631 participants (43.1% men) were included for final analysis. Mean age was 49.8 years (range, 18–92 years). Mean global macular vessel density was 47.3% and 55.1% for the superficial and deep retinal layers, respectively. In multivariate analysis, lower superficial vessel density remained significantly associated with lower signal strength index (SSI; P< 0.001, standardized β= 0.607) and male sex (P< 0.001, β= 0.162), and borderline associated with older age (P= 0.09, β=− 0.045) and longer axial length (AL; P= 0.09, β=− 0.037), while lower deep layer vessel density was significantly associated with lower SSI (P< 0.001, standardized β= 0.667), longer AL (P< 0.001, β=− 0.097), and higher creatinine (P< 0.001, β=− 0.072).

Conclusions: This large population-based study provided normative OCTA data of macular vessel density and demonstrated that a lower superficial retinal vessel density was significantly associated with lower SSI and male sex, while a lower …