Carl Zeiss Meditec

Repeatability of choriocapillaris flow voids by optical coherence tomography angiography in central serous chorioretinopathy

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Purpose To assess the repeatability of flow signal voids (FSV) measurements of the choriocapillaris (CC) and choroid (CH) in central serous chorioretinopathy (CSCR) by Swept-Source optical coherence tomography angiography (SS-OCTA). Methods Cross-sectional study including 104 eyes of 52 patients with unilateral CSCR. Two consecutive macular 6x6 mm SS-OCTA scans (Plex Elite 9000; Zeiss, Dublin, CA) were obtained from the affected eyes with persistent subretinal fluid (SRF) (CSCR group) and the fellow unaffected eyes (control group). FSV area and the number of contours measurements were analyzed using three slabs: inner CC, outer CC and CH. The repeatability of the measurements was assessed with intraclass correlation coefficients (ICC) and coefficients of variation (CV). Results In the CSCR group, ICCs for the FSV area in the three slabs were all ≥0.859, observing higher values for the outer CC and the CH (0.959 and 0.964) than for the inner CC (0.859). Similar ICC values were obt...

Objective Assessment of Retinal Artery Macroaneurysm With Optical Coherence Tomography Angiography

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Retinal artery macroaneurysm (RAM) is an acquired retinal arteriole dilatation with vision-threatening complications. Diagnosis of this condition can be made clinically, supported by multi-modal imaging modalities, commonly optical coherence tomography (OCT) and dye-based angiography studies which show the lesion itself and the complications to the adjacent retina. We report a case of an 83-year-old patient with renal impairment who had the diagnosis and monitoring of RAM done using optical coherence tomography angiography (OCT-A) as an alternative to conventional fluorescein angiography. This case highlighted the use of OCT-A using Cirrus 5000 with AngioPlex (Zeiss, Jena, Germany) as a useful diagnostic and monitoring tool for RAM with its features that enables objective quantification of the disease activity via vessel and perfusion density pre- and post-laser treatment. ( Read Full Article )

Detection of diabetic neovascularisation using single-capture 65{degrees}-widefield optical coherence tomography angiography

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Aim To assess the detection rate of retinal neovascularisation (NV) in eyes with proliferative diabetic retinopathy (PDR) using widefield optical coherence tomography angiography (WF-OCTA) in comparison to ultrawidefield fluorescein angiography (UWF-FA). Methods Single-capture 65°-WF-OCTA-imaging was performed in patients with NV at the disc or elsewhere (NVE) detected on UWF-FA using a modified PlexElite system and B-scans were examined for blood flow signals breaching the internal limiting membrane. Sensitivity of WF-OCTA and UWF colour fundus (UWF-CF) photography for correct diagnosis of PDR was determined and interdevice agreement (Fleiss’ κ) between WF-OCTA and UWF-FA for detection of NV in the total gradable area and each retinal quadrant was evaluated. Results Fifty-nine eyes of 41 patients with PDR detected on UWF-FA were included. Sensitivity of detecting PDR on WF-OCTA scans was 0.95 in contrast to 0.78 on UWF-CF images. Agreement in detecting NVE between W...

Atherosclerosis risk classification with computed tomography angiography: A radiologic-pathologic validation study

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Background and aims The application of machine learning to assess plaque risk phenotypes on cardiovascular CT angiography (CTA) is an area of active investigation. Studies using accepted histologic definitions of plaque risk as ground truth for machine learning models are uncommon. The aim was to evaluate the accuracy of a machine-learning software for determining plaque risk phenotype as compared to expert pathologists (histologic ground truth). Methods Sections of atherosclerotic plaques paired with CTA were prospectively collected from patients undergoing carotid endarterectomy at two centers. Specimens were annotated for lipid-rich necrotic core, calcification, matrix, and intraplaque hemorrhage at 2 mm spacing and classified as minimal disease, stable plaque, or unstable plaque according to a modified American Heart Association histological definition. Phenotype is determined in two steps: plaque morphology is delineated according to histological tissue definitions, followed by...

University of Applied Sciences, Jena Receives a BMBF Grant to Establish a Interdomain Framwork for an AI-based OCT-Data Image Analysis

The University of Applied Sciences, Jena has received a Federal Ministry of Education and Research (BMBF) grant for €799,558 to establish an Open Lab Framework for an AI-based interdomain OCT-Data analysis. The principal investigators are Prof. Dr. Dirk Schmalzried, Prof. Dr. Jens Bliedtner and Prof. Dr. Iwan Schie.   Within the project 'OpenLab AI - OpenLab for Data Analysis and Applied AI' a cross-domain framework for the analysis and processing of optical tomographic image data will be developed, which can be used cross-domain for the investigation of material surfaces in the domain of manufacturing and quality assurance as well as in the domain of medicine, e.g. for investigations of skin and retina data. This framework is intended to be a basis for an interdisciplinary teaching in data competencies in almost all faculties of the University of Applied Science Jena. Through cooperation and networking with local industry (Carl-Zeiss Meditec), research institutes (Leibniz...

Multimodal Imaging in Iris Vascular Tumors: A Case Series


Iris vascular tumors are very unusual and tend to affect middle-aged and older adults. We report a case series of four adult patients with vascular alterations of the iris. Two patients were diagnosed with simple iris arteriovenous malformation (IAVM) and two with iris microhemangiomatosis (IM). Although the diagnosis is typically clinic, multimodal imaging techniques, especially anterior segment fluorescein angiography (AS-FA), anterior segment optical coherence tomography (AS-OCT), and optical coherence tomography angiography (OCT-A), improve the accuracy and delimitation of their attributes and extension. Differential diagnosis with angle or iris neovascularization, melanoma, and other iris vascular tumors is essential to avoid unnecessary tests and treatments. ( Read Full Article )

Classification of Tear Film Lipid Layer en Face Maps Obtained Using Optical Coherence Tomography and Their Correlation With Clinical Parameters

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Purpose: The purpose of this study was to investigate the correlation between the pattern of optical coherence tomography (OCT) en face maps of the tear film lipid layer (TFLL) and lipid layer thickness (LLT), fluorescein breakup time (FBUT), and Schirmer I test values in healthy subjects. Methods: Measurements from four clinical data sets were retrospectively analyzed, and TFLL patterns were classified into 3 categories: homogeneous (HOM), wavy (WAV), or dotted (DOT) appearance. Linear mixed model analyses were performed. Intraclass correlation coefficients and index of qualitative variation were computed to investigate interrater and intrasubject variabilities. Results: For the LLT, a significant difference between HOM and DOT (P < 0.001, βHOMvsDOT = −6.42 nm) and WAV and DOT (P = 0.002, βWAVvsDOT = −4.04 nm) was found. Furthermore, the difference between WAV and DOT regarding FBUT (P < 0.001, βWAVvsDOT = −3.065 seconds) was significant, while no significant differe...

Ultra-widefield OCT Angiography

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Optical Coherence Tomography Angiography (OCTA), a functional extension of OCT, has the potential to replace most invasive fluorescein angiography (FA) exams in ophthalmology. So far, OCTA’s field of view is however still lacking behind fluorescence fundus photography techniques. This is problematic, because many retinal diseases manifest at an early stage by changes of the peripheral retinal capillary network. It is therefore desirable to expand OCTA’s field of view to match that of ultra-widefield fundus cameras. We present a custom developed clinical high-speed swept-source OCT (SS-OCT) system operating at an acquisition rate 8-16 times faster than today’s state-of-the-art commercially available OCTA devices. Its speed allows us to capture ultra-wide fields of view of up to 90 degrees with an unprecedented sampling density and hence extraordinary resolution by merging two single shot scans with 60 degrees in diameter. To further enhance the visual appearance of ...

The CRW1 Index: Identification of Eyes with Previous Myopic Laser Vision Correction Using Only a Swept-Source OCT Biometer

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Purpose: To develop and test a novel index (Cooke-Riaz-Wendelstein, CRW1) that utilizes swept-source optical coherence tomography (SS-OCT) biometry measurements (IOLMaster700, Zeiss Meditec), including total keratometry, to alert clinicians that previous myopic laser vision correction (M-LVC) was present in a measured eye. Design: Retrospective, multicenter, comparative diagnostic analysis METHODS: Setting: Six centers in the United States and Austria STUDY POPULATION: Anonymized SS-OCT biometry datasets acquired between 2018 and 2020 containing 49199 eyes were analyzed. The LVC status, as identified by the biometrist, was used to segregate eyes into LVC and non-LVC eyes. Observation procedures: Data were split into training (10780 eyes) and validation sets (38419 eyes). Subset analysis was performed for CRW1 Index accuracy compared to posterior/anterior corneal curvature ratio (R post /R ant ), topography with corneal analysis software (Atlas 9000 with Pathfinder II, Zeiss Meditec)...

Patterns of Optical Coherence Tomography Imaging in Preperimetric Open Angle Glaucoma: A Comparative Study With Young-Age-Onset and Old-Age-Onset Eyes

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Précis: Optic coherence tomography imaging in preperimetric open angle glaucoma (OAG) differed between young-age-onset and old-age-onset eyes. Inferior and superior quadrants were thinner in young and old-age-onset eyes, respectively. Understanding the specific patterns of early glaucomatous damage based on age-at-onset may improve glaucoma diagnosis and monitoring. Purpose: To investigate the patterns of retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thinning in preperimetric OAG by optical coherence tomography based on age at onset (“young-age onset (<40 y)” vs. “old-age onset (≥40 y)”. Materials and Methods: The RNFL and GCIPL deviation images were acquired by Cirrus HD-optical coherence tomography, and overlaid, thus converted to a “deviation frequency map”, respectively. The topographic thinning patterns and parameters of RNFL and GCIPL thickness measurements were compared. Results: A tot...

Normative Data of Macular Thickness Using Spectral Domain Optical Coherence Tomography for Healthy Jordanian Children

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Purpose: To report normative values of macular thickness and volume by spectral-domain optical coherence tomography (SD-OCT) in the eyes of healthy Jordanian children aged 6– 16 years and assess the correlation of macular parameters with age, sex, and refractive error. Patients and Methods: This observational study included 144 eyes of 144 healthy children. All children underwent comprehensive ocular examination and cycloplegic refraction. Average macular thickness, macular volume, central subfield thickness (CST), and macular thickness for all the Early Treatment Diabetic Retinopathy Study (ETDRS) quadrants were obtained using Primus SD-OCT (Carl Zeiss Meditec). Results: The study group consisted of 68 boys and 76 girls with a mean age (SD) of 10.8 (3.0) years. The mean (SD) spherical equivalent refraction (SER) was 0.56 (1.73) diopters (range: − 4.75 to 4.75). The mean of macular average thickness was 277.2± 12.5 μm, and the mean of the central subfield thick...

The Importance of Signal Strength Index in Optical Coherence Tomography Angiography: A Study of Eyes with Pseudoexfoliation Syndrome

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Purpose: To evaluate the effect of the signal strength index (SSI) on a comparison of the vascular and structural OCT measurements between eyes with pseudoexfoliation syndrome (PXF) and healthy controls of Asian-Indian origin. Methods: In this cross-sectional study, 33 eyes of 33 PXF patients and 40 healthy eyes of 40 controls underwent OCT and OCT angiography (OCTA). Eyes with intraocular pressure (IOP) > 21mmHg, glaucomatous disc changes, or any other ocular pathology were excluded. Peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness were determined from the optic disc scans. Parafoveal VD and ganglion cell complex (GCC) thickness were measured from the macular scans. These parameters were compared between the groups using mixed effect models after adjusting for clinical confounders such as IOP, as well as SSI of the scans. Results: The 2 groups were demographically similar. Average RNFL (94μm vs 100μm, p = 0.01) and GCC (91μm vs 95μm, p...

Glaucoma Detection in Myopic Eyes: Structural and Vascular Assessment by Optic Coherence Tomography Methods

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Precis: Retinal nerve fiber layer thickness is helpful in the diagnosis of glaucoma in myopic eyes but neuroretinal rim thickness is the most valuable measure. However, changes in optical coherence tomography angiography parameters are insufficient for diagnosis of mild to moderate glaucoma in myopia. Purpose: To detect how a multimodal evaluation, which includes retinal nerve fiber layer (RNFL), neuroretinal rim (NRR) thickness, and optic nerve head (ONH) optical coherence tomography-angiography (OCT-A), affects glaucoma diagnosis in myopic patients. Materials and methods: Parameters of healthy myopic and myopic glaucoma eyes with an axial length of ≥24 mm were compared. The ONH structural features and peripapillary RNFL thickness were determined with Cirrus 5000-HD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA). The Cirrus 5000-HD-OCT with AngioPlex was utilized to perform OCT-A imaging. The sensitivity and specificity levels were calculated by the best cut-off values with...

Investigating the macular choriocapillaris in early primary open-angle glaucoma using swept-source optical coherence tomography angiography

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Introduction: There has been a growing interest in the role of vascular factors in glaucoma. Studies have looked at the characteristics of macular choriocapillaris in patients with glaucoma but with conflicting results. Our study aims to use swept-source optical coherence tomography angiography (SS-OCTA) to evaluate macular choriocapillaris metrics in normal participants and compare them with patients with early primary open-angle glaucoma (POAG) (mean deviation better than -6dB). Methods: In this prospective, observational, cross-sectional study, 104 normal controls (157 eyes) and 100 patients with POAG (144 eyes) underwent 3 mm × 3mm imaging of the macula using the Plex Elite 9000 (Zeiss Meditec, Dublin, CA, USA). Choriocapillaris OCTA images were extracted from the device's built-in review software and were subsequently evaluated for the density and size of choriocapillaris flow deficits. Results: After adjusting for confounding factors, the density of flow deficits was ind...

Repeatability and Reproducibility of 4.5 by 4.5 mm Peripapillary Optical Coherence Tomography Angiography Scans in Glaucoma and Non-Glaucoma Eyes

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Précis: Peripapillary vessel parameters from optical coherence tomography angiography (OCTA) 4.5×4.5 mm scans in nonglaucomatous and glaucomatous eyes showed high repeatability and reproducibility, with higher reliability for commercially developed OCTA parameters compared with custom OCTA parameters. Purpose: The purpose of this study was to assess intrasession repeatability versus intersession reproducibility of peripapillary vessel parameters from 4.5×4.5 mm OCTA scans in nonglaucomatous eyes and glaucomatous eyes. Materials and Methods: In a longitudinal study, peripapillary OCTA scans were quantified using research-oriented custom quantification software that calculated vessel area density (VAD) and flux and clinic-oriented commercially developed software (Cirrus 11.0) that calculated perfusion density (PD) and flux index (FI). Intrasession repeatability and intersession reproducibility were evaluated using within-eye coefficient of variation (C...


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