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Retinal Imaging Optical Coherence Tomography Angiography of the Retinal Microvasculature using the ZEISS AngioPlex Expert review by: Giovanni Staurenghi 1 Symposium Speakers: Giovanni Staurenghi, 1 Jose Cunha-Vaz 2 and Jean-Francois Korobelnik 3 1. Department of Biomedical and Clinical Science ‘Luigi Sacco’, Sacco Hospital, University of Milan, Milan, Italy; 2. Department of Ophthalmology, University of Coimbra, and Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; 3. University Hospital Pellegrin, Bordeaux, France Abstract AngioPlex TM optical coherence tomography (OCT) is a new approach to diagnostic imaging in retinal disease. This technology uses amplitude and phase aspects of the OCT signal and novel algorithms to enable highly detailed visualisation of the retinal microvasculature. This system detects capillary flow rather than the presence of an injected dye. Unlike fluorescein angiography (FA), AngioPlex OCT imaging can discriminate capillaries at the superficial and deep retina and can also generate a colour map of the retinal vessels providing unparalleled views of diseased capillaries and net structures. Retinal and choroidal pathologies that are amenable to AngioPlex OCT examination include diabetic retinopathy (DR), vein occlusions, age-related macular degeneration and pathological myopia. In addition, AngioPlex OCT can be used to explore the vasculature of the optic nerve. These applications have considerable potential for improved retinal and choroidal disease diagnosis, but further experience and debate are needed to fully interpret the images. AngioPlex OCT is rapid, non-invasive and improves the patient experience and has been granted US Food and Drug Administration (FDA) 510(k) clearance for clinical use. The convenience and the range of retinal disease applications may encourage widespread adoption of the technology. AngioPlex OCT may therefore become a standard initial examination step for patients with retinal disease prior to and during treatment and may also indicate where further investigations including FA or indocyanine green are necessary. Keywords Optical coherence tomography, angiography, non-invasive ophthalmic vascular imaging Disclosure: Giovanni Staurenghi has been a consultant to Heidelberg Engineering and ZEISS and has received congress presentation fees from Heidelberg Engineering, ZEISS, Optovue and Centervue. Giovanni Staurenghi’s institution has received research grants from ZEISS, Heidelberg Engineering, Canon, Nidek, Optovue and Centervue. Jose Cunha-Vas has received consulting fees/honoraria from Alimera Sciences, Allergan, Bayer, Fovea Pharmaceuticals, GeneSignal, Novartis, OM Pharma, Pfizer, Roche and ZEISS. Jean-Francois Korobelnik has been a consultant to Alcon, Alimera Sciences, Allergan, Bayer, Horus, Novartis, Roche, Thea and ZEISS. He has been an investigator for Allergan, Beyer, Novartis, Roche, Second Sight and Thea. Acknowledgements : Editorial assistance was provided by James Gilbart at Touch Medical Media, funded by ZEISS. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 27 October 2015 Published Online: 23 December 2015 Citation: European Ophthalmic Review, 2015;9(2):147–56 Correspondence: Giovanni Staurenghi, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Sacco Hospital, University of Milan, via GB Grassi, 74, 20157 Milan, Italy. E: Support: This article was supported ZEISS. The views and opinions expressed are those of the speakers and not necessarily those of ZEISS. This article reports the proceedings of a sponsored satellite symposium held at the EURETINA 2015 Congress and, as such, has not been subject to this journal’s usual peer-review process. This report was reviewed for scientific accuracy by Giovanni Staurengh before publication. Optical coherence tomography (OCT) has proved to be a valuable approach to imaging ocular vasculature and is becoming a critical method in precisely diagnosing the type and identifying the location of retinal disease. 1–7 Fluorescein angiography (FA), used to examine the retinal microvasculature, to date has produced valuable diagnostic information and insights into the pathophysiology of retinal disease. FA continues to be an important diagnostic method in retinal disease but its use necessitates an intravenous injection of dye for each analysis. The advantage of OCT angiography is that it is a rapid, higher-contrast and less-invasive technique, which helps to diagnose and monitor retinal disease and treatment. There are now more than three approaches to OCT angiography: this article reports the application of the new AngioPlex OCT angiography technology on CIRRUS HD-OCT in specific pathologies. Specific cases of its application were discussed at a symposium convened by ZEISS in Nice, France during the September 2015 EURETINA Congress. TOU CH MED ICA L MEDIA AngioPlex Optical Coherence Tomography Angiography – An Overview AngioPlex TM OCT angiography is a new technology that runs on the ZEISS CIRRUS HD-OCT instruments, and can be enabled on existing instruments with new software and minor hardware upgrades. This approach uses the entire OCT signal, and utilises FastTrac TM and Optical Micro Angiography Complex [OMAG C ] algorithms to visualise microvasculature. AngioPlex uses both amplitude and phase aspects of the OCT signal, which is different from other systems that only use one. A scanning laser diode scans each retinal position up to four times and eye motion during the scans is corrected with live-tracking using FastTrac technology (see Figure 1). Although the OCT angiography field of view is limited to 3 mm by 3 mm or 6 mm by 6 mm, the scan can be positioned over an area of neovascularisation. FastTrac allows this area to be scanned on subsequent visits to monitor changes with progression of disease, or 147