A Paradigm Shift in Practice: How ZEISS CIRRUS 6000 and AngioPlex OCT Angiography Redefine My Workflow

Having used ZEISS OCT technology since the Stratus days, I can say that upgrading to ZEISS CIRRUS 6000 has been a noticeable improvement and a true paradigm shift in visualization. The advances in image quality, speed, and analytical capabilities have significantly improved how I manage both non-exudative and exudative disease, and the benefits of OCT angiography (OCTA) using AngioPlex OCTA on ZEISS CIRRUS 6000 has elevated my diagnostic and prognostic capacities.

In an era of treatments for non-exudative disease, the ability to accurately track progression of geographic atrophy (GA) is more relevant than ever. This is where the ZEISS Advanced RPE Analysis on ZEISS CIRRUS 6000 has become essential in my practice.

• Visual and Numerical Data: ZEISS Advanced RPE Analysis creates a visual and numerical representation of atrophic changes in the macula. It provides quantifiable data, including the total area of atrophy and, importantly, the distance between the atrophy and the fovea. 
• Tracking Change Over Time: For me, the most important function is the ability to compare scans over time and analyze the rate of change. For a slowly progressive disease such as GA, these longitudinal data offer a clear characterization of growth trends. For example, I can show a patient two images comparing their atrophy from two timepoints—say, a current visit showing atrophy within 500 µm from the fovea and an image from 2 years ago showing atrophy within 1200 µm of the fovea. ZEISS CIRRUS 6000 is a powerful tool for patient education helps patients and their families understand what is happening and why intervention might be necessary.
  

When managing exudative disease, early detection and clinical efficiency are important. ZEISS CIRRUS 6000 delivers three major benefits:

1. Faster Image Acquisition: ZEISS CIRRUS 6000 is much faster than previous ZEISS OCT models, acquiring 100,000 A-scans per second. This offers a significant workflow advantage: capturing high-quality images faster means that you spread the benefits of accurate image acquisition across many more patients throughout the day.
2. Improved Image Resolution: The enhanced resolution of ZEISS CIRRUS 6000 allows better identification of intraretinal and subretinal fluid. This is a great advantage for early detection, as you can more easily pick up on subtle hyporeflective spaces that represent fluid, even with concomitant pathology present.
3. Enhanced Depth Image Analysis: The ability to see deeper into the choroid better quantification of pathology at the subretinal level. In cases with fluid of unclear origin, I use enhanced depth imaging on ZEISS CIRRUS 6000 to characterize anatomy and correlate fluid to its source. This often removes the need for a more invasive fluorescein angiogram.
   

I have used AngioPlex OCTA software regularly for nearly 2 years, and it has become an invaluable diagnostic and prognostic tool. It rapidly assesses retinal and choroidal vasculature at all levels, from the inner retinal layers down to sub-RPE tissue and choroidal vessels. This capability allows me to characterize choroidal neovascularization in conditions such as proliferative diabetic retinopathy and retinal vein occlusion without an angiogram.

Beyond diagnostics, AngioPlex is an excellent prognostic indicator. By visualizing capillary dropout and non-perfusion, I can better inform a patient about what to expect with treatment. I use these data to create customized treatment plans, infors my decision-making about the likelihood of success, and determine the ceiling of a potential treatment benefit.

The combination of ZEISS CIRRUS 6000 and AngioPlex OCTA significantly advances how I manage retinal conditions. The ability to precisely quantify and follow atrophic disease with Advanced RPE Analysis on ZEISS CIRRUS 6000 enhances patient counseling and disease characterization. For exudative cases, improvements in acquisition speed, image resolution, and depth analysis enhance both clinic workflow and my ability to connect fluid to its source. Finally, upgrading to ZEISS AngioPlex OCTA software provides prognostic insights that allow highly personalized treatment strategies based on underlying vasculature. This integrated imaging approach ultimately supports deeply informed decisions and enables accurate management of patient expectations.

^{The statements of the author reflect only his personal opinions and do not necessarily reflect the opinions of any institution with whom he is affiliated.
The author has a contractual or other financial relationship with Carl Zeiss Meditec, Inc. and has received financial support.}