New AngioVue Software Streamlines

OCTA Interpretation
Qienyuan Zhou, PhD
Vice President, Clinical Affairs, Optovue, Inc.
WHITEPAPER

New AngioVue Software Streamlines ®

OCTA Interpretation
Qienyuan Zhou, PhD
Vice President, Clinical Affairs, Optovue, Inc.

Optical coherence tomography angiography (OCTA) with AngioVue generates depth-resolved images of the
®

vascular structure of the retina and the choroid with capillary details. Previously, interpretation of OCTA data
required understanding of projection artifacts throughout the OCTA volume and manually adjusting boundaries
of en face slabs, which is time-consuming, lacks consistency across observers and makes assessing change over
time particularly challenging. The new AngioVue software improves and streamlines OCTA data interpretation
by removing projection artifacts from the entire OCTA volume, and by providing predefined en face slabs
based on appropriately selected anatomical boundaries for consistency across subjects and, within a subject,
across visits. This consistency is necessary for both qualitative and quantitative assessment for single visits, and
more importantly for assessing change over time.

3D PAR (3D Projection Artifact Removal)

Projection artifacts, common to all OCTA technologies, affect the visualization of the deeper retinal vascular
structures, CNV, and choroid. With 3D PAR, projection artifacts are minimized pixel-by-pixel throughout the
entire OCTA volume, facilitating clearer visualization of vascular structures in en face images and in B-scans at
all depths, as illustrated in Fig. 1 (Note the in-situ CNV signal more easily visualized in the B-scan with 3D PAR).

Figure 1: Effectiveness of 3D PAR illustrated in the Outer Retina en face image and B-scan image of a CNV case (3mm x 3mm
AngioRetina scan). (Image courtesy of Eric D. Nudleman, MD and Michael H. Goldbaum, MD of Shiley Eye Institute, University of
California at San Diego, La Jolla, CA.)

1
 WHITEPAPER
New segmentation and predefined en face slabs
The new software provides additional retina layer boundaries segmentation, including OPL (outer plexiform
layer) outer boundary segmentation and BRM (Bruch’s membrane) boundary segmentation, in addition to
previously available segmentation boundaries (ILM, IPL, ISOS, RPE). Predefined en face slabs (Fig. 2) are
provided within the software, consistent with the slab segmentations recommended by Campbell et al, and 1

enable the following

• The addition of OPL to ILM and IPL facilitates consistent en face slab definition across subjects and across
visits for the superficial vascular complex (Superficial or SVC, from ILM ~ IPL–10µm) slab and deep
vascular complex (Deep or DVC, from IPL–10µm to OPL+10µm) slab.

• The addition of OPL and BRM facilitates the use of predefined en face slabs for the outer retina avascular
zone (from OPL+10µm to BRM–10µm), providing a consistent, anatomically appropriate en face slab for
CNV evaluation across patients and over time.

• The choriocapillaris slab (from BRM–10µm to BRM+30µm) provides a consistent basis for the evaluation
of the choriocapillaris across patients and over time.

• The predefined en face slabs provide a consistent basis for vessel density analysis of the Superficial and
the Deep vasculature complex (Fig. 3).

• The retinal en face slab (Retina, from ILM to OPL+10µm) provides a consistent basis for the evaluation of
the FAZ (Fig. 3).

Figure 2: The five predefined en face slabs in the software are illustrated with a DR case (3mm x 3mm AngioRetina scan). (Image
courtesy of Eric D. Nudleman, MD and Michael H. Goldbaum, MD of Shiley Eye Institute, University of California at San Diego,
La Jolla, CA.)

2
WHITEPAPER

Figure 3: The predefined en face slabs provide consistent basis for vessel density analysis of the Superficial slab and the Deep
slab, as well as FAZ analysis of the Retina slab as illustrated with the DR case (3mm x 3mm AngioRetina scan). (Image courtesy of
Eric D. Nudleman, MD and Michael H. Goldbaum, MD of Shiley Eye Institute, University of California at San Diego, La Jolla, CA.)

To provide flexibility in en face visualization for clinical and research purposes, a custom en face slab is
provided with user-definable adjustable boundaries. Use of the custom slab in conjunction with 3D PAR
facilitates visualization of vasculature in the inner region of the INL (i.e., ICP) and vasculature in the outer region
of the INL (i.e., DCP) as illustrated in Fig. 4.

Segmentation editing and automatic propagation

Correct segmentation is required for appropriate and consistent definition of en face slabs for qualitative and
quantitative evaluation, and for assessing change over time. Error in automatic segmentation can occur in some
cases. With the new Edit/Propagation tool, users can manually correct one or a few affected B-scans and
propagate the correction throughout the entire scan volume or through a user-selected region in under one second.

3
 WHITEPAPER
Figure 4: Custom slab can be set to provide en face images of the ICP slab or the DCP slab of a normal case; the predefined
DVC slab en face image is shown for comparison (3mm x 3mm AngioRetina scan).

Figure 5: Example of BRM (Bruch’s membrane) segmentation editing/propagation in a CNV case (3mm x 3mm AngioRetina
scan). (Image courtesy of Pravin Dugel, MD, Retinal Consultants of Arizona, Phoenix, AZ.)

4
WHITEPAPER

New montage
Large field of view OCTA images, with good capillary details and fast processing time, can be generated
through an automatic montage of 2 scans (Fig. 6): one 6mm x 6mm high-density (HD) AngioRetina scan and
one 6mm x 6mm HD AngioDisc scan.

Figure 6: Example of automatic montage of two 6mm x 6mm HD Angio scans of a BRVO case (image courtesy of Theodore
Leng, MD, Byers Eye Institute, Stanford University, Palo Alto, CA.)

Assessment of change
The software provides a multi-scan view that effectively facilitates assessment of change over time, benefitting
from consistent slab definition and registered B-scans across visits (Fig. 7).

Figure 7: Example of multi-scan view of Outer Retina slab of a CNV case followed longitudinally from December 2014 through
August 2015 (3mm x 3mm AngioRetina scans). (Image courtesy of Adil El Maftouhi, OD, Centre Rabelais, Lyon, France.)

5
 WHITEPAPER
New quantitative analysis of RPC vessel density and optic nerve structure
With the simultaneously acquired OCT and OCTA volume of the AngioVue scan, structural and vascular analyses
®

can be derived in parallel with exact correspondence in analyzed regions. The AngioVue optic disc scan is ®

particularly advantageous for optic nerve head (ONH) morphological analysis due to minimized distortions from
motion artifacts, as a result of previously released DualTrac Motion Correction for OCTA imaging. DualTrac
™

comprises two levels of correction for motion artifacts, correction of lateral eye motion artifacts in the 3D volume
through active tracking and axial motion artifact correction in the post-processing phase. This is achieved by
merging two orthogonally scanned volumes, thus eliminating distortion and preserving the shape of the ONH.

As illustrated in the example below of a 4.5mm x 4.5mm HD AngioDisc scan of a glaucomatous eye (Fig. 8),
the new AngioVue software provides ONH analysis, RNFL thickness measurements, and RPC (radial peripapillary
capillaries) vessel density analyses. The disc margin is automatically detected based on Bruch’s Membrane
Opening (BMO), and both cup and rim are measured within the BMO plane. The peripapillary sectors
approximate the trajectory of the RNFL bundles, starting with the sector definition initially proposed by Garway-
Heath et al, and adapted to the wider peripapillary region based on work by Tan et al.
2 3

Figure 8: Quantitative analysis of peripapillary nerve fiber layer thickness, RPC

Vessel Density, and Optic Nerve head morphology of a glaucoma case (4.5mm
x 4.5mm AngioDisc scan). (Image courtesy of Robert N. Weinreb, MD, Hamilton
Glaucoma Center, University of California at San Diego, La Jolla, CA.)

The new AngioVue software was developed by the Optovue team of algorithm development scientists, software engineers, clinical
scientists and SQA engineers. Note: AngioAnalytics software is not FDA-cleared for sale in the U.S.
TM

References:
1. J. P. Campbell*, M. Zhang*, T. S. Hwang, S. T. Bailey, D. J. Wilson, Y. Jia & D. Huang. Detailed Vascular Anatomy of the Human Retina by
Projection-Resolved Optical Coherence Tomography Angiography. Nature Scientific Reports | 7:42201 (2017) | DOI: 10.1038/srep42201.
2. D. F. Garway-Heath, D. Poinoosawmy, F. W. Fitzke, R. A. Hitchings. Mapping the Visual Field to the Optic Disc in Normal Tension Glaucoma
Eyes. Ophthalmology, 2000 Oct;107(10):1809-15.
3. O. Tan, L. Liu, L. Liu, D. Huang. Nerve Fiber Flux Analysis Using Wide-Field Swept Source Optical Coherence Tomography. Translational Vision
Science & Technology, 2017, in press.

6
 Our vision is foresight

2800 Bayview Drive, Fremont, CA 94538 +1.510.623.8868 optovue.com

©2017 Optovue, Inc. Optovue, AngioVue, AngioAnalytics and DualTrac are trademarks or registered
trademarks of Optovue, Inc. All rights reserved.