Purpose To evaluate retinal vascular parameters by optical coherence tomography angiography (OCT-A) in iron deficiency anemia (IDA). Methods Thirty-two patients with IDA (study group) and 30 healthy children (control group) were enrolled in the study. All subjects underwent a complete ocular examination. OCT-A scans were performed in a 6 x 6 mm area centered on the macula. Foveal avascular zone (FAZ), non-flow area (NFA), FAZ perimeter (PERIM), acircularity index (AI) of FAZ, and foveal density (FD) were measured in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). SCP and DCP were also scanned centered on the optic disk. Hemoglobin (Hb), mean corpuscular volume (MCV), serum iron, total iron-binding capacity (TIBC), and ferritin were also studied and compared for both groups. Results The mean age was 12.22 +/- 4.48 years (ranged 5-18 years) in the study group and 12.37 +/- 3.76 years (ranged 6-18 years) in the control group. The mean FAZ value was 0.290 +/- 0.09 mm(2) in the study group and 0.298 +/- 0.11 mm(2) in the control group. The mean NFA value was 0.477 +/- 0.10 mm(2) in the study group and 0.486 +/- 0.13 mm(2) in the control group (p > 0.05). FD and AI were not statistically significant between the study group and control group (p > 0.05). The mean value for SCP was statistically significant between the study group and control group (p < 0.05). The mean value for DCP was not significantly different between the study and control groups (p > 0.05). The mean values for capillary density on optic disk were also statistically significant between the study group and control group (p < 0.05). A negative correlation was found between serum iron, TIBC, and capillary plexus density (p < 0.05). A positive correlation was found between MCV and ferritin values and capillary plexus density (p < 0.05). Conclusion IDA had significantly lower capillary plexus density. We detected retinal microvascular changes in young IDA patients before significant ocular anomalies, especially ischemic changes, developed.