AttaAllah HR, , et al. - In this prospective observational case-control study, researchers examined the impact of iron overload on macular perfusion among transfusion-dependent thalassemia (TDT) patients using optical coherence tomography angiography (OCTA). The sample consisted of 27 children with transfusion-dependent β-thalassemia (27 eyes) and 25 age-matched controls (25 eyes). All candidates were assessed clinically and with OCTA Avanti RTVue-XR system (Optovue) to evaluate macular microvascular changes, by measuring vessels density and foveal avascular zone area, at both superficial and deep retinal plexuses and at choriocapillaris level. Macular microvascular changes were detected by OCTA examination in TDT patients, primarily due to the iron overload effect, because the authors chose patients who were taking iron-chelating agents with the least harmful effect on the retina. The deep capillary plexus is the most affected layer. Deep layer changes in those patients could be used as a sensitive biomarker for early macular perfusion changes.