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To evaluate the frequency and associated factors of artifacts in swept-source optical coherence tomography (SS-OCT) imaging. This was a population-based cross-sectional study. Individuals aged 35 years or older, residing in the Yuexiu district of Guangzhou, China, were recruited by random cluster sampling. Nearly half of the participants were randomly selected for SS-OCT imaging centered on the optic nerve head. Six types of artifacts in the peripapillary choroidal layer and retinal nerve fiber layer (RNFL) were graded and identified. Univariate and multivariate logistic regression analyses were used to investigate the association between the presence of artifacts and clinical characteristics. Out of the 616 eligible individuals who underwent SS-OCT imaging, 18.3% and 13.6% of subjects exhibited at least one artifact in peripapillary RNFL (pRNFL) and peripapillary choroidal thickness (pCT) measurements, respectively, with posterior segmentation error and off-center artifact ranked as the most common artifacts. The presence of artifacts was significantly associated with age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01–1.06;  p  = .003), refractive error (OR, 0.80; 95% CI, 0.71–0.89;  p  &lt; .001), and signal strength (OR, 0.95; 95% CI, 0.90–0.997;  p  = .039) in pRNFL thickness measurement. Similarly, the presence of artifacts in pCT measurement was significantly associated with age (OR, 1.05; 95% CI, 1.03–1.08;  p  &lt; .001), and refractive error (OR, 0.76; 95% CI, 0.68–0.86;  p  &lt; .001). Nearly one-fifth of the eyes were noted with at least one artifact in the population-scale SS-OCT study. Age was a risk factor for the presence of artifacts and should be considered in clinical settings.

Segmentation Errors and Off-Center Artifacts in SS-OCT: Insight from a Population-Based Imaging Study