Background Macular-foveal capillarization (MFC), characterized by abnormal vascularization within the foveal avascular zone (FAZ), arises from congenital or acquired factors and may occur in healthy individuals with normal vision.

Objective To report a case of MFC identified during flight cadets' medical selection in an adolescent with normal vision and review relevant literature, so as to provide reference for air force medical selection.

Methods The candidate underwent routine fundus examination. Retinal structure was assessed using ultra-wide-angle fundus photography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Visual function was evaluated with multifocal electroretinogram (mfERG), Rabin cone contrast testing and visual field testing.

Results This 18-year-old male cadet exhibited diminished foveal reflex and reduced area of the FAZ upon fundus examination. OCT/OCTA demonstrated foveal hypoplasia, with capillaries traversing the foveal center connecting to the surrounding retinal capillary network. mfERG showed a reduced central peak response.

Conclusion In the medical selection for flight pilot candidates, in addition to routine visual acuity examinations, the active use of fundus examinations as well as new technologies and equipment such as OCT and OCTA for auxiliary assessments can effectively identify potential microstructural abnormalities in the fundus that may affect visual performance during high-performance flight. This approach holds significant value in enhancing the scientific rigor and precision of the selection process.