An image processing device comprises an enhancement processing unit that enhances a speckle pattern in an ocular fundus tomographic image. A region-of-interest setting unit sets a desired region in the ocular fundus tomographic image with the enhanced speckle pattern as a region-of-interest, and a feature value extracting unit extracts a feature value of the speckle pattern in the region-of-interest. A disease determining unit makes disease determination for an ocular fundus on the basis of the feature value, and a mapping unit maps, in the ocular fundus tomographic image, a site of the ocular fundus that is determined to have a disease. An image processing method comprises enhancing a speckle pattern in an ocular fundus tomographic image; setting a desired region in the ocular fundus tomographic image with the enhanced speckle pattern as a region-of-interest; extracting a feature value of the speckle pattern in the region-of-interest; and making disease determination for an ocular fundus on the basis of the feature value.