Purpose <p>To investigate ocular circulation characteristics and their association with cardiac function in patients with heart failure with preserved ejection fraction (HFpEF).</p> Study design <p>Prospective observational study.</p> Methods <p>This prospective study included 15 patients with and 15 individuals without HFpEF. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), laser speckle flowgraphy (LSFG), and optical coherence tomography angiography (OCTA) were assessed. LSFG was performed to evaluate blood flow in the optic nerve head (ONH) and macula; OCTA was performed to evaluate macular microvascular parameters. Patients with HFpEF underwent echocardiography to evaluate their cardiac function.</p> Results <p>Mean blur rate (MBR), a blood flow parameter of LSFG, in HFpEF eyes was significantly reduced in the ONH and macula compared with individuals without HFpEF (<i>p</i>=0.0002; ONH, <i>p</i>=0.0012; macula). ONH-MBR correlated with E/e', a marker for left ventricular diastolic dysfunction measured using echocardiography (r=−0.67, <i>p</i>=0.011). The foveal avascular zone, measured using OCTA, was significantly enlarged in patients with HFpEF (<i>p</i>=0.018) and correlated with BCVA (r=0.58, <i>p</i>=0.0009). CRT and CCT in patients with HFpEF were significantly thinner compared with those in individuals without HFpEF (<i>p</i>=0.011, CRT; <i>p</i>=0.010, CCT).</p> Conclusion <p>Ocular circulatory and chorioretinal structural changes may be detectable in patients with HFpEF using LSFG and OCT/OCTA.</p>