Epilepsy is a common chronic neurological disorder where the excessive electrical discharge in cerebral cell groups result in recurrent seizures [1]. The recurrent electrographic seizures result in various cerebral changes, both neurodegenerative and pathological [2].

The same neural tissue ends up as the neurosensory retina and the brain, resulting in a similar morphological and physiological structure [3]. Many studies have been conducted on cerebral blood flow in epileptic patients. Previous studies on epileptics being treated with antiepileptic drugs (AEDs) have reported decreased glucose metabolism and blood flow [4], [5], [6]. The eye and brain are connected by the same nerves (the sympathetic nervous system) and arteries (the carotid arterial network), creating a hemodynamic continuum [7].

The vascular networks of the various retinal layers and choriocapillaris (CC) of the macular region, and also the peripapillary region of the optic nerve head (ONH), can be visualized without the need to inject a dye by using the non-invasive imaging method of optical coherence tomography angiography (OCT-A) [8]. It provides reproducible, quantitative, and detailed information on the macular superficial capillary plexuses (SCP) and deep capillary plexuses (DCP), CC plexuses, and the peripapillary area, with vessel density (VD) ratios [9]. In addition, a new method for evaluating choroidal vascular architecture using a binarization method has provided further details of the luminal and vascular parts of the choroid [10].

Up to 30% of epileptic patients have been reported to suffer from visual impairment [11]. The reason could be the disease itself or the antiepileptic drug (AED) treatment [7]. The current study aimed to evaluate whether decreased ocular perfusion accompanied the decreased cerebral blood flow independently of antiepileptic drug use in epilepsy patients. Thus, we wanted to demonstrate the possible contribution of decreased ocular hemodynamics to the neurodegenerative process and visual impairment in epilepsy patients. The optic disc, retina, and choroid VD parameters were assessed with the OCT-A device and the enhanced depth imaging (EDI) mode spectral domain optical coherence tomography (SD-OCT) in order to evaluate the choroidal vascular structure in children newly diagnosed with epilepsy who did not receive medical treatment, and these parameters were then compared to healthy subjects.