bioRxiv preprint, under review

Optical coherence tomography angiography (OCTA) has been extensively explored for the detection of pathological retinal changes arising in various ophthalmological diseases. Due to phase instability of conventional systems, most OCTA signal processing methods to date have relied on intensity-based averaging, despite the resulting lower contrast and dynamic range compared to coherent averaging approaches. In this work, we (1) present a novel computation pipeline that enables fully-coherent processing in any phase-stable or phase-unstable system, and (2) demonstrate the first angiography metric with integrated signal-to-noise ratio (SNR) correction and coherent spatiotemporal ensemble averaging effective in any OCT system. Our method does not rely on 2D en face projections or binarization to produce high-contrast en face views and it significantly enhances the contrast-to-noise ratio of computed OCTA volumes, particularly in regions with reduced SNR levels. Our OCTA volumes also have high cross-sectional quality, enabling the use of single-depth en face views and the localization of capillary paths in the axial dimension. We can now identify capillaries below the retinal pigment epithelium, near the lamina cribrosa in the optic cup, which was not previously possible due to low SNR. We also conducted an analysis of strategies for bias reduction in OCTA and developed the optimal method utilizing coherent spatiotemporal ensemble averaging. Because our method leverages coherent averaging across all dimensions, it provides flexibility in shaping the averaging kernel to target specific workflows. The value of this additional degree of freedom is illustrated in our vessel tracing investigations, in which the depth resolution was maximized by limiting coherent ensemble averaging to the two lateral dimensions even in presence of strong phase noise, enabling the identification of 3D features such as overlapping capillary paths.