Gaps in AS-OCTA for limbal ischemia assessment

This Letter to the Editor comments on the role of anterior segment optical coherence tomography angiography (AS-OCTA) in the early assessment of chemical or thermal ocular surface injuries. Repurposed posterior-segment platforms with small-field scans (3 × 3 mm) limit visualization of circumferential limbal ischemia and are prone to motion, shadowing, and segmentation artifacts, potentially distorting quantitative metrics. Because AS-OCTA cannot assess leakage, vessel maturity, or perfusion, fluorescein and indocyanine green angiography remain essential for detecting deep vessels and guiding therapy and surgery. Dedicated anterior segment devices and a multimodal approach are recommended. In the current technological context, AS-OCTA–derived prognostic readouts should be interpreted with caution.