A clinical comparison is underway via the Vision-FFR trial, which is testing whether vFFR derived from optical coherence tomography can match performance against traditional optical coherence tomography measurements in chronic coronary syndromes. The trial targets an important category of lesions—intermediate coronary stenoses—where angiography alone often leaves uncertainty about whether intervention improves outcomes. The reporting frames the clinical challenge as a persistent decision gap in catheterization labs: stenoses in the 40% to 80% diameter range can appear neither clearly harmless nor clearly culpable. Vision-FFR’s design aims to tighten the functional readout that guides therapy. For device and diagnostics developers, the study reflects the continuing shift toward physiology-informed assessment and AI-adjacent imaging workflows that can standardize decision-making at the point of care.