PURPOSE: The purpose of this study was to compare standard 85 kilohertz (kHz) and newer high-speed 125 kHz optical coherence tomography angiography (OCTA) scanning modes in healthy and diseased eyes, assessing differences in acquisition time, image quality, and quantitative vascular metrics. METHODS: This retrospective cross-sectional study included 200 eyes from 100 consecutive patients with a wide range of retinal diseases and healthy controls. Each eye underwent OCTA imaging at both 85 kHz and 125 kHz using 10 × 10 mm fields of view. Acquisition time was measured manually and automatically using the Heidelberg log file. Three retinal slabs, the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC),were analyzed. Two masked retinal specialists graded images for clinical utility and motion artifacts. Quantitative vascular metrics were extracted using AngioTool version 2.0, and Q-scores were recorded for all scans. Main outcome measures included acquisition time, Q-score, qualitative grading, and quantitative vascular parameters across the three slabs. RESULTS: High-speed 125 kHz scans significantly reduced mean acquisition time compared with 85 kHz (P < 0.001). Q-scores did not differ significantly between modes (P = 0.37). Qualitative grading favored 125 kHz scans, showing improved interpretability and fewer motion artifacts. Quantitative vascular metrics across SCP, DCP, and CC demonstrated no significant differences between scan speeds. CONCLUSIONS: High-speed 125 kHz OCTA markedly decreases acquisition time without compromising image quality, Q-score, or quantitative vascular parameters, supporting its use in routine and research imaging. TRANSLATIONAL RELEVANCE: Adoption of 125 kHz OCTA may enhance clinical workflow and patient comfort while preserving quantitative reliability, enabling more efficient high-speed imaging in practice.