This is article was written in partnership with Carl Zeiss Meditec, a supporter of NewGradOptometry & new graduate optometrists 😎
ZEISS Medical Technology is set to preview a new software upgrade for the CIRRUS HD-OCT
We’ve got some exciting news!
Our friends from ZEISS have told us the new CIRRUS HD-OCT software release, coming soon, is going to feature some incredible updates!
It doesn’t take much to convince an eye care provider that the OCT might be the most valuable tool in a practice when it comes to the treatment and management of ocular disease. With these new updates, the CIRRUS HD-OCT, the “workhorse” of many practices, has become even more valuable and will offer even greater utility.
The new features will help clinicians when it comes to managing:
- Anterior Segment Disease
- General Ocular Wellness
All of these features will be compatible with the CIRRUS HD-OCT 5000/500, though an instrument upgrade to Windows 10 OS will be required.
The update has been designed to not only help clinicians manage patients more effectively, but provides an automation to the patient-doctor workflow to create greater practice efficiency, which will improve data capture, patient experience, and practice revenue.
Here are the major updates with the new CIRRUS HD-OCT software upgrade:
- AngioPlex® Montage
- AngioPlex® for the Optic Nerve Head
- Epithelial Thickness Mapping
- Wellness Exam
1. AngioPlex Montage
If you manage patients with diabetes, or other retinal pathologies, you are going to love this new feature, that will allow you to better manage disease affecting the central and peripheral retina. You’ll be able to leverage AngioPlex Montage for widefield visualization of the retinal vasculature in a quick, streamlined scanning workflow.
Figure 1: 14×10 mm Montage of six 6×6 mm OCTA Scans
What is the user interface like?
The interface was designed with both doctor and patient in mind. The CIRRUS will automatically guide the user through the montage sequence, provide patients with an automatic fixation target and scan placement. You’ll have the ability to preview the montage during scan review and retake any individual scans as needed.
Figure 2. OCTA Montage Acquisition Process
What does the review software look like?
This is where you’ll be blown away! The Montage Analysis and Segmentation allows clinicians to quickly assess all retinal layers, including:
- Vitreo-Retinal Interface (VRI)
- Outer Retina Choriocapillaris (ORCC) (NEW)
Note: You will also be able to analyze individual montage scans with the existing Angiography Analysis.
Figure 3: Montage Analysis and Segmentation
Check out this example!
Figure 4: PDR with areas of ischemia and NVE. VRI slab isolates multiple areas of NVE Courtesy of Dr. Scott Lee, East Bay Retina Consultants, Oakland, CA, USA.
This is a game changer when it comes to our ability to detect changes from disease like diabetic retinopathy. Not only that, but these images can serve as a valuable patient education tool.
2. AngioPlex for the Optic Nerve Head
What is it?
Anyone who treats and manages glaucoma knows that blood flow of the optic nerve is supplied by two main sources including the posterior ciliary artery and the central retinal artery. 
We also know that blood flow to the retinal nerve fiber layer surrounding the optic nerve head is supplied by microcirculation coming from the radial peripapillary capillaries (RPC).
Learn more about leveraging OCT for glaucoma management.
One major advantage of OCTA over traditional fluorescein angiography, is that the RPC network can be visualized with OCTA but not with FA. 
New AngioPlex ONH scan (4.5 x 4.5 mm)
Visualization of the Radial Peripapillary Capillary (RPC) Network
Figure 5: AngioPlex for ONH reveals blood vessels at the lamina cribrosa level and highlights late stage cupping as in the advanced glaucoma image in the above right image.
What does this mean?
As our understanding of the RPC and its role in glaucoma evolves, this technology will better help us understand and correlate vasculature to what is going on in the RNFL. We now have the ability to make these scans part of our normal glaucoma workup.
3. Epithelial Thickness Mapping (ETM)
CIRRUS will now be able to provide a full 9-mm epithelial thickness map in addition to pachymetry map. For anyone who co-manages refractive surgery patients, this information is invaluable.
Likewise, if you manage keratoconus or dry eye in your practice, the ability to acquire a baseline map of the epithelium prior to initiating dry eye treatment, or using this data as an aide in helping diagnose keratoconus, is yet another great application of this tool. Epithelial thickness maps may help differentiate subclinical keratoconus from normal corneas where topography alone may be equivocal.
Figure 6: ETM highlights localized epithelial thinning due to keratoconus
Why is this important?
Anyone that co-manages refractive surgery patients knows that careful analysis of the eye both pre and post operatively is paramount to setting expectations for success and identifying the best candidates and identifying risks. With this new update, clinicians will be able to track the cornea both pre and post surgically.
Additionally, clinicians will be able to monitor and assess the corneal epithelium prior to, during, and after initiating treatments of disease that affect the anterior segment like ocular surface disease.
4. Ocular Wellness Exam
This update will appeal to both the practice that manages a lot of disease as well as the “average” practice. Wellness has increasingly become a primary focus in healthcare. Eye care is no exception, and in fact, many practices have offered “wellness packages” to patients in order to capture baseline data, serve as a patient education tool, and provide an incredible revenue stream for their practices.
Read more about widefield imaging.
The Wellness Exam feature in the CIRRUS HD-OCT, update gives clinicians a simple way to add health evaluation services to their practices by providing a single-page report with widefield OCT assessment of both the macula and optic nerve head.
Figure 7: Wellness Report
Once again, automation and workflow efficiency is key here as this information can be obtained with a simple click of a button. One great advantage of the CIRRUS HD-OCT wellness scans, is that these scans are the same macular and optic nerve head cube scans eye care providers are accustomed to capturing in patients with macular and optic nerve head disease. This means these scans can also be used in Guided Progression Analysis™.
The other major advantage of this wellness solution offered in the software update, is that this wellness option is “widefield,” focusing on both the optic nerve head and macula, rather than just concentrating on the macula alone.
We have a direct partnership with ZEISS!
- Hayreh SS. Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc. Br J Ophthalmol 1969;53:721‑748.
- Spaide RF, Klancnik JM, Cooney MJ. Retinal Vascular Layers Imaged by Fluorescein Angiography and Optical Coherence Tomography Angiography. JAMA Ophthalmol 2015;133:45‑50.