Interpretation Guide: OCT Angiography and Integrated Diagnostic Imaging

Interpretation Guide
OCT Angiography and

integrated diagnostic imaging
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Multi-modality retinal imaging
with OCT Angiography (OCTA)
enables you to capture ultra-clear
images of retinal and choroidal
microvasculature in seconds.
As a clinician, this allows you to have a

new level of confidence when suggesting
a treatment regimen that is customized
to your patient’s individual needs.
In eye clinics worldwide, multi-modality

in diagnostics and imaging is fast
becoming the standard of care.
3
Table of Contents
Branch Retinal Vein Occlusion (BRVO) .................. 5

Neovascular AMD ...................................................... 6-9
Central Serous Chorioretinopathy (CSC) ............... 10-12
Ischemic diabetic maculopathy ............................... 13-14
Non-proliferative DR ................................................. 15-16
Exudative CNV ............................................................ 17-18
4
Branch Retinal Vein Occlusion (BRVO)
Patient History
53-year-old female
Summary
In contrast to a single
6x6 mm or 8x8 mm
scan, the AngioPlex ®
Montage—with up to
a 50-degree field of
view—is able to reveal 1
the extent of ischemia,
providing a more
complete clinical picture.
5
Patient History
53-year-old female
Summary
6x6 mm or 8x8 mm
The 14x14 mm AngioPlex Montage,
X
view—is able to reveal consisting of five 8x8 mm superficial scans,
1
reveals large areas of ischemia outside the
the extent of ischemia, posterior pole.
providing a more
5
Patient History
53-year-old female
Summary
6x6 mm or 8x8 mm
view—is able to reveal 1
the extent of ischemia,
providing a more
Vessel abnormalities and

X
2 collateral vessels can be clearly
seen in OCTA.
5
Neovascular Age-related Macular Degeneration (AMD)
Patient History
Patient presented with
1
a history of neovascular
AMD in the right eye,
which has been treated
with anti-VEGF.
More »
6
Neovascular Age-related Macular Degeneration (AMD)
Patient History X
Patient presented with Color fundus image shows small areas of RPE disruption and atrophy at
1
a history of neovascular the macula as well as areas of discoloration temporal to the macula.
AMD in the right eye,
which has been treated
with anti-VEGF.
More »
6
Neovascular AMD
Fundus autofluorescence
imaging (FAF) is
2
indicated in geographic
atrophy to document
the location and size of
disease.
More »
7
Neovascular AMD
Fundus autofluorescence X
imaging (FAF) is On this FAF Blue (FAF-B) image, autofluorescence at the macula is
2 obscured by naturally-occurring macular pigment, resulting in a dark
indicated in geographic area on the image.
atrophy to document
the location and size of
disease.
More »
7
Neovascular AMD
FAF Green (FAF-G) is

better at visualizing the
3
macular area, since it is
not affected by macular
pigment.
More »
8
Neovascular AMD
FAF Green (FAF-G) is X

better at visualizing the In this case, there is a small area of atrophy at the macula, which is
3
macular area, since it is obscured on the FAF-B image but clearly visible on the FAF-G image.
not affected by macular
pigment.
More »
8
Neovascular AMD
Summary
Integrated diagnostic
imaging allows the
clinician to quickly
monitor all aspects of the
disease, from accurately
documenting the location
and the extent of
geographic atrophy using
color and FAF images, to
monitoring for subretinal
fluid with OCT.
With the addition of

non-invasive OCTA,
clinicians can monitor
CNV with more 4 5
frequent follow ups
and appropriate, timely
referrals when needed.
For outside U.S. only

9
Neovascular AMD
Summary X
The OCT B-scan shows irregular RPE contour; increased visibility of the
4 choroid can be seen in one area, indicating RPE atrophy. No subretinal
imaging allows the fluid is seen on B-scan.
and the extent of
fluid with OCT.

non-invasive OCTA,
CNV with more
5
frequent follow ups

9
Neovascular AMD
Summary
Integrated diagnostic X
imaging allows the Choriocapillaris OCTA slab overlaid onto the fundus image shows a
5
clinician to quickly Type-1 choroidal neovascular membrane beneath the fovea.
and the extent of
fluid with OCT.

non-invasive OCTA,
CNV with more
4
frequent follow ups

9
Neovascular AMD
Summary
imaging allows the
and the extent of
fluid with OCT.

non-invasive OCTA,
CNV with more
4 5
frequent follow ups

9
Central Serous Chorioretinopathy (CSC)
Patient History
70-year-old male. Patient presented with complaints of decreased vision in the right eye.
More »
1 2 3
108 RETINA - CSCR, CNV/SRF, (OD) 3 visits- 108 RETINA - CSCR, CNV/SRF, (OD) 3 visits- 108 RETINA - CSCR, CNV/SRF, (OD) 3 visits-
Name: Name: Name:
MacCube, Angio: 3x3 MacCube, Angio: 3x3 MacCube, Angio: 3x3
ID: 108 RETINA Exam Date: 11/9/2015 CZMI ID: 108 RETINA Exam Date: 11/23/2015 CZMI ID: 108 RETINA Exam Date: 7/22/2016 CZMI
DOB: 1/1/1948 Exam Time: 9:53 AM DOB: 1/1/1948 Exam Time: 9:17 AM DOB: 1/1/1948 Exam Time: 8:47 AM
Gender: Other Serial Number: 5000-4464 Gender: Other Serial Number: 5000-4429 Gender: Other Serial Number: 5000-4618
Technician: Operator, Cirrus Signal Strength: 9/10 Technician: Operator, Cirrus Signal Strength: 9/10 Technician: Operator, Cirrus Signal Strength: 8/10
Macula Thickness : Macular Cube 512x128 OD OS Macula Thickness : Macular Cube 512x128 OD OS Macula Thickness : Macular Cube 512x128 OD OS
ILM-RPE Thickness (µm) Fovea: Not found ILM-RPE Thickness (µm) Fovea: 256, 64 ILM-RPE Thickness (µm) Fovea: 244, 64
Overlay: ILM - RPE Transparency: 50 % Overlay: ILM - RPE Transparency: 50 % Overlay: ILM - RPE Transparency: 50 %
ILM - RPE ILM - RPE ILM - RPE
ILM ILM ILM
RPE RPE RPE
Central Cube Central Cube Central Cube

Cube Cube Cube
Subfield Average Subfield Average Subfield Average
Volume Volume Volume
Thickness Thickness Thickness Thickness Thickness Thickness
(mm³) (mm³) (mm³)
(µm) (µm) (µm) (µm) (µm) (µm)
ILM - RPE 473 11.0 304 ILM - RPE 365 10.4 289 ILM - RPE 246 10.1 282
Comments Doctor's Signature Comments Doctor's Signature Comments Doctor's Signature

SW Ver: 11.0.0.29946 SW Ver: 11.0.0.29946 SW Ver: 11.0.0.29946
Copyright 2018 Copyright 2018 Copyright 2018
Carl Zeiss Meditec, Inc Carl Zeiss Meditec, Inc Carl Zeiss Meditec, Inc
All Rights Reserved
Page 1 of 1 Analysis Edited: 10/4/2017 11:33 AM
All Rights Reserved
Page 1 of 1
All Rights Reserved
Page 1 of 1 10
Patient History
More »
X
Exam 1: Macular cube scan
1 indicates fluid at the macula 2 3
Name: consistent with CSCR. Follow
108 RETINA - CSCR, CNV/SRF, (OD) 3 visits-
MacCube, Angio: 3x3
Name:
MacCube, Angio: 3x3
Name:
MacCube, Angio: 3x3
ID:
DOB:
Gender: Other
up required.
108 RETINA
1/1/1948
Exam Date:
Exam Time:
Serial Number:
11/9/2015
9:53 AM
5000-4464
CZMI ID:
DOB:
Gender:
108 RETINA
1/1/1948
Other
Exam Date:
Exam Time:
Serial Number:
11/23/2015
9:17 AM
5000-4429
CZMI ID:
DOB:
Gender:
108 RETINA
1/1/1948
Other
Exam Date:
Exam Time:
Serial Number:
7/22/2016
8:47 AM
5000-4618
CZMI
ILM ILM ILM
RPE RPE RPE

Cube Cube Cube
(mm³) (mm³) (mm³)

All Rights Reserved
All Rights Reserved
Page 1 of 1
All Rights Reserved
Page 1 of 1 10
Patient History
More »
1 2 3
Name: Name: Name:
ILM ILM ILM
RPE RPE RPE

Cube Cube Cube
(mm³) (mm³) (mm³)

All Rights Reserved
All Rights Reserved
Page 1 of 1
All Rights Reserved
Page 1 of 1 10
Patient History
More »
X
Exam 2: Two weeks later,
1 2 patient reports improved vision. 3
Name:
MacCube, Angio: 3x3
Name: Macular cube scan shows fluid
MacCube, Angio: 3x3
Name:
MacCube, Angio: 3x3
ID:
DOB:
Gender:
108 RETINA
1/1/1948
Other
Exam Date:
Exam Time:
Serial Number:
11/9/2015
9:53 AM
5000-4464
CZMI ID:
DOB:
Gender:
is decreasing.
108 RETINA
1/1/1948
Other
Exam Date:
Exam Time:
Serial Number:
11/23/2015
9:17 AM
5000-4429
CZMI ID:
DOB:
Gender:
108 RETINA
1/1/1948
Other
Exam Date:
Exam Time:
Serial Number:
7/22/2016
8:47 AM
5000-4618
CZMI
ILM ILM ILM
RPE RPE RPE

Cube Cube Cube
(mm³) (mm³) (mm³)

All Rights Reserved
All Rights Reserved
Page 1 of 1
All Rights Reserved
Page 1 of 1 10
Patient History
More »
1 2 3
Name: Name: Name:
ILM ILM ILM
RPE RPE RPE

Cube Cube Cube
(mm³) (mm³) (mm³)

All Rights Reserved
All Rights Reserved
Page 1 of 1
All Rights Reserved
Page 1 of 1 10
Patient History
More »
Exam 3: Eight months later,

X
1 2 3 patient reports normal vision.
Name:
MacCube, Angio: 3x3
Name:
MacCube, Angio: 3x3
Name:
Macular cube scan shows some
MacCube, Angio: 3x3
ID:
DOB:
108 RETINA
1/1/1948
Exam Date:
Exam Time:
11/9/2015
9:53 AM
CZMI ID:
DOB:
108 RETINA
1/1/1948
Exam Date:
Exam Time:
11/23/2015
9:17 AM
CZMI ID:
DOB: disruption. B-scan also shows
108 RETINA
1/1/1948
Exam Date:
Exam Time:
7/22/2016
8:47 AM
CZMI
Technician: Operator, Cirrus Signal Strength: 9/10 Technician: Operator, Cirrus Signal Strength: 9/10
small amount of remaining
Technician: Operator, Cirrus Signal Strength: 8/10
fluid.
ILM ILM ILM
RPE RPE RPE

Cube Cube Cube
(mm³) (mm³) (mm³)

All Rights Reserved
All Rights Reserved
Page 1 of 1
All Rights Reserved
Page 1 of 1 10
Patient History
More »
1 2 3
Name: Name: Name:
ILM ILM ILM
RPE RPE RPE

Cube Cube Cube
(mm³) (mm³) (mm³)

All Rights Reserved
All Rights Reserved
Page 1 of 1
All Rights Reserved
Page 1 of 1 10
CSC
The patient was 4

scanned using OCTA,
and a quick overview
of the OCTA slab
thumbnails identifies
the slabs needing
further evaluation.
More »
11
CSC
X
The patient was 4 In standard practice, this case would not warrant FA. However, the patient
was scanned using OCTA, and a quick overview of the OCTA slab thumbnails
scanned using OCTA, identifies the slabs needing further evaluation.
of the OCTA slab
the slabs needing
further evaluation.
More »
11
CSC
The patient was 4

scanned using OCTA,
of the OCTA slab
the slabs needing
further evaluation.
More »
11
CSC
Summary 5
OCTA reveals the
presence of CNV in a
way that the standard
OCT B-scan or macular
cube scan cannot,
thereby elevating
confidence before a
patient is referred for
anti-VEGF injections.
12
CSC
X
Summary 5 RPE to RPE fit slab reveals CNV.
OCTA reveals the
cube scan cannot,
thereby elevating
confidence before a
12
CSC
Summary 5
OCTA reveals the
cube scan cannot,
thereby elevating
confidence before a
12
CSC
Summary 5
OCTA reveals the
cube scan cannot,
thereby elevating
confidence before a
12
Ischemic Diabetic Maculopathy
Patient History
This patient was first
imaged on a traditional
fundus camera.
Color fundus images

as well as fluorescein
angiography images
were taken prior to OCT 1
Angiography.
More »
13
Patient History
fundus camera.
Color fundus images

angiography images
1 Exam 1: Traditional color fundus shows hemorrhages, exudates X
were taken prior to OCT
and microaneurysm. Corresponding fluorescein angiography (FA) reveals
Angiography.
ischemic diabetic maculopathy. In 2011 and 2012, the patient returned for
their second and third follow-up exams, during which additional FA images
taken revealed a loss of macular capillaries over time and growth of new
More »
vessels in the macula respectively.
13
Patient History
fundus camera.
Color fundus images

angiography images
were taken prior to OCT 1
Angiography.
More »
2 Exam 4 (2016): During the fourth exam, the limited FoV of the color
X
fundus image suggests that the hemorrhages have improved. Whereas, the
FA image shows reperfusion of the macula.
13
Summary
In such cases, OCTA
may be comparable to
FA and preferred since
OCTA is much quicker,
non-invasive and more
comfortable for the
patient.
14
Summary
In such cases, OCTA
may be comparable to
FA and preferred since
OCTA is much quicker,
non-invasive and more
comfortable for the
patient.
Additionally in 2016, the patient was scanned using OCTA. The 3D X

3
segmentation capabilities of OCTA isolate the superficial capillaries,
confirming the findings in the FA.
14
Non-Proliferative Diabetic Retinopathy (NPDR)
Patient History
57-year-old, diabetic male,
presented with blurry vision, 1
worse in the right eye.
Physical exam of the patient

was unremarkable. There was OD
no refractive error change; best-
corrected visual acuity was 20/30
and 20/25 in the right and left
eye, respectively. There were no
lens changes. Upon dilated fundus
exam, mild NPDR was noted in
both eyes, with no DME seen.
More »
OS
15
Non-Proliferative Diabetic Retinopathy (NPDR)
Patient History X
Because of the unexplained reduced VA, OCT was
57-year-old, diabetic male, performed to study the macula in more detail. Structural
presented with blurry vision, 1
B-scans showed trace DME OD, no DME OS. Foveal contour
worse in the right eye. was intact, and no other obvious disease was noted.
Physical exam of the patient

was unremarkable. There was OD
no refractive error change; best-
corrected visual acuity was 20/30
and 20/25 in the right and left
eye, respectively. There were no
lens changes. Upon dilated fundus
exam, mild NPDR was noted in
both eyes, with no DME seen.
More »
OS
15
NPDR
Summary
OD OS
OCTA imaging revealed macular
ischemia in both eyes, which
explained the reduced visual acuity.
OCTA is quick and non-invasive,

providing valuable insight into
the health status of the eye and
allowing clinicians to evaluate
the retinal vasculature when
fluorescein angiography may not 2
be indicated. This is especially
helpful for diabetic patients, since
some studies show that capillary 3
dropout on OCTA may precede
visible retinopathy.
In this case, the patient was

educated on the need for good
compliance with follow ups and
treatment to prevent further
vision loss.
16
NPDR
Summary
OD OS

the retinal vasculature when OCTA was then performed. The 3x3 mm scan showed X
fluorescein angiography may not 2 significant macular ischemia OD>OS, characterized by an
be indicated. This is especially enlarged and irregular FAZ.
helpful for diabetic patients, since
some studies show that capillary 3

vision loss.
16
NPDR
Summary
OD OS

the retinal vasculature when
fluorescein angiography may not 2
be indicated. This is especially
helpful for diabetic patients, since Areas of capillary dropout throughout the posterior pole X
some studies show that capillary 3 were also revealed, better seen with the 6x6 mm image.

vision loss.
16
Exudative CNV
Patient History
A 52-year-old white male 1
was referred to the clinic
for retinal evaluation.
The patient complained
of sudden onset of
decreased central vision
in the right eye for the
past 2 days.
More »
17
Exudative CNV
Patient History X
Color fundus image reveals white subretinal lesion with surrounding
A 52-year-old white male 1 subretinal hemorrhage. OCT B-scan confirms location of lesion,
was referred to the clinic subretinal fluid is seen.
of sudden onset of
past 2 days.
More »
17
Exudative CNV
Patient History
A 52-year-old white male 1
was referred to the clinic
of sudden onset of
past 2 days.
More »
17
Exudative CNV
Summary
OCTA clearly reveals the
CNV lesion in greater
detail. In this case, FA
may not be needed to
make the diagnosis and
plan treatment.
As the technology
advances, OCTA may
complement FA exams 2
for certain diseases.
18
Exudative CNV
Summary
OCTA clearly reveals the
CNV lesion in greater
detail. In this case, FA
may not be needed to
make the diagnosis and
plan treatment.
As the technology
advances, OCTA may
complement FA exams 2
for certain diseases. Superficial retinal vasculature on OCTA mostly intact. However, X
further segmenting the avascular layer of the retina (outer retina)
reveals Type 2 CNV.
18
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Interpretation Guide

OCT Angiography and

As a clinician, this allows you to have a

In eye clinics worldwide, multi-modality

Branch Retinal Vein Occlusion (BRVO) .................. 5

Vessel abnormalities and

FAF Green (FAF-G) is

FAF Green (FAF-G) is X

With the addition of

For outside U.S. only

With the addition of

For outside U.S. only

With the addition of

For outside U.S. only

With the addition of

For outside U.S. only

ILM - RPE ILM - RPE ILM - RPE

ILM ILM ILM

RPE RPE RPE

Central Cube Central Cube Central Cube

Comments Doctor's Signature Comments Doctor's Signature Comments Doctor's Signature

ILM - RPE ILM - RPE ILM - RPE

ILM ILM ILM

RPE RPE RPE

Central Cube Central Cube Central Cube

Comments Doctor's Signature Comments Doctor's Signature Comments Doctor's Signature

ILM - RPE ILM - RPE ILM - RPE

ILM ILM ILM

RPE RPE RPE

Central Cube Central Cube Central Cube

Comments Doctor's Signature Comments Doctor's Signature Comments Doctor's Signature

ILM - RPE ILM - RPE ILM - RPE

ILM ILM ILM

RPE RPE RPE

Central Cube Central Cube Central Cube

Comments Doctor's Signature Comments Doctor's Signature Comments Doctor's Signature

ILM - RPE ILM - RPE ILM - RPE

ILM ILM ILM

RPE RPE RPE

Central Cube Central Cube Central Cube

Comments Doctor's Signature Comments Doctor's Signature Comments Doctor's Signature

Exam 3: Eight months later,

ILM - RPE ILM - RPE ILM - RPE

ILM ILM ILM

RPE RPE RPE

Central Cube Central Cube Central Cube

Comments Doctor's Signature Comments Doctor's Signature Comments Doctor's Signature

ILM - RPE ILM - RPE ILM - RPE

ILM ILM ILM

RPE RPE RPE

Central Cube Central Cube Central Cube

Comments Doctor's Signature Comments Doctor's Signature Comments Doctor's Signature

The patient was 4

The patient was 4

Color fundus images

Color fundus images

Color fundus images

Additionally in 2016, the patient was scanned using OCTA. The 3D X

Physical exam of the patient

Physical exam of the patient

OCTA is quick and non-invasive,

In this case, the patient was

OCTA is quick and non-invasive,