We thank Tan and associates for their interest in our article. Projection artifacts are one of the most important artifacts affecting optical coherence tomography angiography (OCTA) images. This produces false images of vessels at deeper locations in the eye than they actually exist. Our graders were aware of the presence of these artifacts and attempted to exclude projections of the superficial vascular network when outlining the boundaries of the deep foveal avascular zone (FAZ). Nevertheless, there was less interobserver agreement for the deep compared to the superficial FAZ area. That being said, we agree that projection artifacts may have also contributed to the indefinite borders observed at the deep FAZ. Such ill-defined borders would account for less reliability of deep FAZ measurements using both manual and automated techniques.

Stable fixation and subject cooperation are important requirements for reducing OCTA motion artifacts and obtaining images with acceptable quality. We, too, have repeatedly encountered this in our practice. In our experience, explaining some basic principles of image acquisition beforehand results in better subject cooperation and higher-quality images, even in older subjects. Repeating the scans is also helpful in this regard.

We agree with Tan and associates on the importance and clinical applicability of normative studies describing FAZ dimensions and correlations. Considering the variability of “normal” FAZ size and shape and the similarity between fellow eyes, contralateral eye comparison could serve as a valuable control measure.