Ultrahigh speed spectral / Fourier domain optical coherence tomography (OCT) using a CMOS line scan camera with image acquisition rates of 70,000 -312,500 axial scans per second is investigated. Several design configurations are presented to illustrate design 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 with 4096 camera pixels, 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. We show dense homogeneous 3D-OCT volumetric data sets that were acquired by raster scanning at 250,000 axial scans per second, which is an order of magnitude faster than most current generation spectral / Fourier OCT instruments. OCT fundus images constructed from the 3D-OCT data have no noticeable discontinuity of retinal features and show that there are minimal motion artifacts. Using an improved sensitivity roll-off configuration at 70,000 axial scans per second, long cross sectional scans are acquired at high resolution for imaging large areas of the retina, including the fovea and optic disk. Using an ultrahigh speed configuration at 250,000 axial scans per second, the fine porous structures of the lamina cribrosa can be seen from slices extracted from a dense 3D data set. 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. This capability could create the possibility for alternative techniques for quantifying capillary blood flow, which cannot be measured with Doppler OCT methods because of the capillary's perpendicular orientation to the optical beam. 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 quantitative measurements and enabling more sensitive assessment of disease progression or response to therapy.