Objective: This study aims to explore the value of retinal vessel density (VD) in diagnosing optic nerve injuries in patients with pituitary adenomas using optical coherence tomography angiography (OCTA). Methods: In this cross-sectional retrospective study, 100 patients with pituitary adenomas and 71 participants for normal controls, who visited the Beijing Tiantan Hospital from January 2019 to May 2021, were enrolled. The OCTA was used to measure retinal thickness and VD, and the correlation of these parameters with visual field (VF) factors was analyzed. Receiver operating characteristic curves were used to compare the value of the above parameters in diagnosing VF abnormalities in the patients with pituitary adenomas; the differences in retinal VD between 41 patients with pituitary adenomas who had normal retinal thicknesses and 41 patients in the normal control group with no statistical differences in gender and age were compared. Results: The radial peripapillary capillary (RPC) density, superficial retinal capillary plexus (SRCP) density, retinal nerve fiber layer thickness, and ganglion cell layer complex thickness correlated with VF parameters (p 0.05). The RPC density in the temporal quadrant had the highest capability in diagnosing VF abnormalities, with an area under the curve = 0.821, p 0.001, with 72.3% sensitivity and 82.7% specificity. The mean RPC density and RPC density in the nasal and temporal quadrants in the 41 patients with pituitary adenomas who had normal retinal thicknesses were reduced compared with the normal control group (49.95% \pm 1.86% vs. 51.30% \pm 1.87%, p = 0.002; 49.09% \pm 3.13% vs. 50.41% \pm 3.90%, p = 0.034; 54.33% \pm 3.14% vs. 55.89% \pm 3.08%, p = 0.020) and other parameters had no statistical differences compared with the normal control group. Conclusions: The density of the RPC and SRCP may also be sensitive and specific indicators of VF damage in patients with pituitary adenomas. Measuring retinal VD in patients with pituitary adenomas may be a supplement to help identify VF impairments. In addition, abnormal retinal vascular density may indicate VF impairment in patients who are unable to cooperate with VF examinations.