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Purpose . To compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) images of foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) with and without diabetic macular ischemia (DMI). Methods . The Wilcoxon signed-rank test was used to compare area measurements and p values of <0.05 were considered statistically significant. FA and OCTA images were independently graded by 2 observers that reached agreement regarding quantitative DMI according established protocols. The ischemic area was divided into "large" macular ischemia (superior to 0.32 mm 2 ) and "small" (inferior to 0.32 mm 2 ) groups. Quantitative analyses of the FAZ were performed using custom software. Results . Thirty-four eyes from 34 diabetic patients were enrolled. Subjects with DMI presented a mean area on FA and OCTA of 0.68 ± 0.53 mm 2 and 0.58 ± 0.35 mm 2 , respectively ( p = 0.1374). Patients without DMI presented a mean area on FA and OCTA of 0.19 ± 0.67 mm 2 and 0.20 ± 0.79 mm 2 , respectively ( p = 0.9594). The ICC for the FAZ measurements between the 2 observers on FA and OCTA was 0.96 and 0.92, respectively. Conclusion . OCTA represents a novel technique for the diagnosis of DMI and it may become an alternative to FA for this purpose., Competing Interests: All authors have no financial disclosures.