Ultrahigh speed spectral / Fourier domain optical coherence tomography (OCT) imaging using a CMOS line scan camera with acquisition rates of 70,000 - 312,500 axial scans per second is investigated. Several design configurations are presented to illustrate trade-offs between acquisition speed, sensitivity, resolution and sensitivity roll-off performance. We demonstrate: extended imaging range and improved sensitivity roll-off at 70,000 axial scans per second , high speed and ultrahigh resolution imaging at 106,382 axial scans per second, and ultrahigh speed imaging at 250,000-312,500 axial scans per second. Each configuration is characterized through optical testing and the trade-offs demonstrated with in vivo imaging of the fovea and optic disk in the human retina. OCT fundus images constructed from 3D-OCT data acquired at 250,000 axial scans per second have no noticeable discontinuity of retinal features and show that there are minimal motion artifacts. The fine structures of the lamina cribrosa can be seen. Long cross sectional scans are acquired at 70,000 axial scans per second for imaging large areas of the retina, including the fovea and optic disk. Rapid repeated imaging of a small volume (4D-OCT) enables time resolved visualization of the capillary network surrounding the INL and may show individual red blood cells. The results of this study suggest that high speed CMOS cameras can achieve a significant improvement in performance for ophthalmic imaging. This promises to have a powerful impact in clinical applications by improving early diagnosis, reproducibility of measurements and enabling more sensitive assessment of disease progression or response to therapy.© (2009) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.