Optovue Company Confidential

Angio-OCT User’s Guide

By Tony Ko

September 21, 2014

Latest Software Version: 2014.2.0.75

Please Note: This guide provides instruction on Optovue’s

Angio-OCT software that is currently in development and is not
a released product. It is for the benefit of Optovue’s research
collaborators only, and it should not be viewed as a guide on
the features and specifications of the final product.

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Installation and Activation

1. Download the latest version of the software using the link provided by Optovue
2. Back up the current bin folder in C:\RTOCT folder by renaming it (reboot the machine if
you cannot rename the bin folder because it is being used by the RTVue software)
3. Right click on the latest software update file and select “Run as administrator” and allow
the program to install
4. After the installation is complete, you can start the XR Avanti program and activate the
AngioVue license per the following instruction.
5. In the XR Avanti program, click help > Upgrade, select SSADA and click OK

6. In license key, enter “sssss-sssss-sssss”, click manual activation

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7. Copy the request code and either email or text the code to Tony Ko or another
designated Optovue personnel. Do not contact Service for this Beta software activation,
they do not know anything about it.
8. We will email or text back to you the “Activation Code” and you can type it into the XR’s
activation window and click OK
9. This shall allow you to activate the Angio scans (check that the Angio Retina and Angio
Disc scans are available to be selected)

Changing the Default Settings

1. In this version of the software, you should change the following default settings
2. Go to Tools -> User Preference
3. The "Auto saving .png imag" should be unchecked (after version 2014.2.0.68)
4. If the user prefers to skip the OverVue that comes on by default whenever an Angio
scan is opened for review, change the “Default 3D View” and “Default 3D Retina View”
from “OverVue” to “3D Overview”

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Scan Acquisition and Parameters (General Information)

1. The new Angio-OCT software has improved acquisition speed and scan quality over the
previous clinical prototype software
2. Unlike the previous prototype software, only one FastX (horizontal raster) set and one
FastY (vertical raster) set are performed for each acquisition scan (replacing the
previous 2 FastX and 2 FastY sets). Each set takes approximately 3 seconds to complete.
3. The patient is allowed to replenish their tear film by either closing or blinking their eyes
in the pause between the acquisition of the FastX and FastY sets. However, the subject
should keep their fixation as close to the same position as possible for the two
acquisition sets, and the subject should not move their head out of the chin rest in
between the two sets.
4. After the acquisition of one set (either FastX or FastY), the operator can review the first
Angio en face image to determine if the subject had blinked or had excessive motion
(blinks show up as black bands and saccades show up as bright and thin white lines in
the Angio en face image). The operator can chose to keep the scan or rescan the
subject if there are blinks or too much motion artifacts the dataset.
5. After the completion of the FastX and FastY sets, the software will perform the motion
correction technology (MCT) to remove saccades and minor loss of fixation. After
motion correction is performed, the results are automatically saved into the database
6. Each Angio-OCT 3D volume set is consisting of 304x304 pixels in the transverse
dimension. The allowable sizes in the “Angio Retina” scan using this sampling density
can be 2x2, 3x3, 6x6, or 8x8 mm. The 3x3 mm scan is the default recommended scan for
the retina region because it provides sufficient density to visualize retinal capillaries.
The 6x6 mm scan is the recommended scan for performing a larger area scan of the
retina.
7. The allowable sizes in the “Angio Disc” scan using the same sampling density can be 3x3
or 4.5x4.5 mm. The 4.5x4.5 mm scan is the default recommended scan for the disc
region because it is large enough to cover most subject’s disc region and it also provides
the sufficient information on the capillaries in the peripapillary region.
8. By default, all Angio scans use the Vitreoretinal mode of acquisition. Preliminary
research results indicate that this acquisition mode has better reproducibility and
repeatability when performing Angio quantification measurements in the macula and
disc regions. If the researcher desired to perform Angio scans using the Chorioretinal
mode of acquisition, it can be changed in the Manual adjustment tab during the
acquisition.

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Detailed Acquisition Instructions (Angio Retina)

1. Type in Patient information, go to the scan tab
2. Select the eye to be scanned (OD or OS)
3. Select the “Angio Retina” under the “Retina” scan group

4. The following is the “Auto” page for the Angio Retina scan. The 3x3 mm scan size is
selected by default. The operator can only change the scan size using the buttons on
this front page (unlike previous version, only 4 sizes are allowed now)

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5. The operator should push the machine toward the subject until a good view of the
fundus can be seen on the IR camera image (lower right box).
6. The operator can optimize the OCT signal position and signal quality by using the “Auto
All” function which performs in sequence the “Auto Z” to find the best position for
obtaining the retina OCT image, the “Auto F” to find the best focus for the particular
subject’s refraction, and the “Auto P” to find the best polarization match for the
particular subject’s ocular polarization.
7. After the first “Auto All” is performed for a particular eye, the optimized parameters are
saved and the operator should not have to perform the “Auto All” function again for this
eye if the OCT signal appears to be optimized. If the OCT signal appears to be less than
optimal, the operator should perform the “Auto All” function again.
8. The following is the “Manual” page for the Angio Retina scan. The scan size (Length,
Width, and Angle) and Fixation Controls are not adjustable in this page. Other
parameters can be adjusted to improve the IR video quality (Brightness, Contrast) or
manually adjust the Z, F, and P motor positions if the Auto Z, Auto F, and Auto P routines
failed to generate the motor position for the most optimized OCT signal. Auto Z, Auto F,
and Auto P can also be run individually from this screen by clicking on the buttons next
to their respective motor position indications.

9. By default, all Angio scans use the Vitreoretinal mode of acquisition. If the researcher
wishes to change to Chorioretinal mode of acquisition for enhanced OCT signal in the
choroid, it can be selected in this Manual page.
10. After optimizing the fundus image in the IR video and the OCT signal using the Auto
functions, place the live OCT image in between the two red dashed lines in the

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acquisition box. Left click once on the acquisition box and you can use the mouse scroll
wheel to move the OCT B-scan up or down in relation to the dashed red lines.
11. When the position is optimized, ask the patient to blink and hold their fixation for about
3 seconds. Click the green checked mark on the bottom of the software screen or the
button on the joystick to start the acquisition. You will see the progress bar below the
IR image start to fill up.
12. After the completion of the FastX (horizontal raster) scan, the program will prompt the
operator to “Continue” to the FastY scan, “Rescan” the FastX scan, or “Cancel” the
entire acquisition session. At this point, the program will show the Angio FastX image
(without motion correction) on the top left box above the IR image. The thin horizontal
white lines in this Angio image indicate eye motion or saccades that took place during
this FastX acquisition. The operator should determine whether to “Rescan” the FastX
scan if there are any blinks or excessive motion in the FastX dataset. The subject is
allowed to replenish their tear film by either closing or blinking their eyes at this point.
However, the subject should not move their head out of the chin rest.

13. For the FastY (vertical raster) scan, the subject should keep their fixation as close to the
same position as possible to the FastX (horizontal raster). The FastY scan will already
have the optimized OCT parameters, so no Auto All is required. Place the live OCT
image in between the two red dashed lines in the acquisition box. In this case, you
should be able to move the scanner toward or away from the subject to achieve the
optimal position in between the two red dashed lines.
14. When the position is optimized, prepare the patient to stay fixated on blue fixation
target (it is harder to do in the FastY vertical raster scan) and ask the patient to blink and
hold their fixation for about 3 seconds.

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15. Click the green checked mark on the bottom of the software screen or the button on the
joystick to start the acquisition. You will see the progress bar below the IR image fill up
as shown in the example below. Also, the yellow arrow on the top right of the OCT
image window will show a vertical arrow to indicate the vertical raster scan (FastY) is
being performed.

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16. After the completion of the FastY (vertical raster) scan, the program will prompt the
operator to “Continue and Save” to go ahead and perform the Motion Correction
Technology (MCT) routine and save the result, “Rescan” the FastY scan, or “Cancel” the
entire acquisition session. At this point, the program will show the Angio FastY image
(without motion correction) on the top left box above the IR image. The thin vertical
white lines in this Angio image indicate eye motion or saccades that took place during
this FastY acquisition. The operator should determine whether to “Rescan” the FastY
scan if there are any blinks or excessive motion in the FastY dataset. At this point, the
subject is done with the Angio acquisition and can relax and/or close their eyes.

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17. After selecting “Continue and Save” button, the program will prompt the operator to
perform the Motion Correction Technology (MCT) routine and save the result. At this
point, the program will show the Angio-OCT image (with motion correction) on the top
left box above the IR image. The operator should assess the performance of the MCT to
remove all the white line artifacts caused by eye motion and saccades. If the result of
this Angio Retina image is not satisfactory, another scan can be performed immediately
without having to evaluate the previous scan in the Review screens.

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Detailed Acquisition Instructions (Angio Disc)

1. Type in Patient information, go to the scan tab
2. Select the eye to be scanned (OD or OS)
3. Select the “Angio Disc” under the “Nerve Fiber” scan group

4. The following is the “Auto” page for the Angio Disc scan. The 4.5x4.5 mm scan size is
selected by default. The operator can only change the scan size using the buttons on
this front page (unlike previous version, only 2 sizes are allowed now for the disc)

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5. The following is the “Manual” page for the Angio Disc scan. The scan size (Length,
Width, and Angle) and Fixation Controls are not adjustable in this page. Other
parameters can be adjusted to improve the IR video quality (Brightness, Contrast) or
manually adjust the Z, F, and P motor positions if the Auto Z, Auto F, and Auto P routines
failed to generate the motor position for the most optimized OCT signal. Auto Z, Auto F,
and Auto P can also be run individually from this screen by clicking on the buttons next
to their respective motor position indications.

6. By default, all Angio scans use the Vitreoretinal mode of acquisition. If the researcher
wishes to change to Chorioretinal mode of acquisition for enhanced OCT signal in the
choroid, it can be selected in this Manual page.
7. After optimizing the fundus image in the IR video, make sure the white box indicating
the scan area is centered on the optic disc (click the center cross of the white box in the
IR image and you can use your mouse to drag the box around to center it on the optic
disc).
8. Optimize the OCT signal using the Auto functions, place the live OCT image in between
the two red dashed lines in the acquisition box (for the disc, it may not be possible to fit
into the two red lines as in this example. In that case, just fit the B-scan in the entire
OCT scan window as much as possible). Left click once on the acquisition box and you
can use the mouse scroll wheel to move the OCT B-scan up or down in relation to the
dashed red lines.
9. When the position is optimized, ask the patient to blink and hold their fixation for about
3 seconds. Click the green checked mark on the bottom of the software screen or the
button on the joystick to start the acquisition. You will see the progress bar below the
IR image start to fill up.

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10. After the completion of the FastX (horizontal raster) scan, the program will prompt the
operator to “Continue” to the FastY scan, “Rescan” the FastX scan, or “Cancel” the
entire acquisition session. At this point, the program will show the Angio FastX image
(without motion correction) on the top left box above the IR image. The thin horizontal
white lines in this Angio image indicate eye motion or saccades that took place during
this FastX acquisition. The operator should determine whether to “Rescan” the FastX
scan if there are any blinks or excessive motion in the FastX dataset. The subject is
allowed to replenish their tear film by either closing or blinking their eyes at this point.
However, the subject should not move their head out of the chin rest.

11. For the FastY (vertical raster) scan, the subject should keep their fixation as close to the
same position as possible to the FastX (horizontal raster). The FastY scan will already
have the optimized OCT parameters, so no Auto All is required. Place the live OCT
image in between the two red dashed lines in the acquisition box. In this case, you
should be able to move the scanner toward or away from the subject to achieve the
optimal position in between the two red dashed lines.
12. When the position is optimized, prepare the patient to stay fixated on blue fixation
target (it is harder to do in the FastY vertical raster scan) and ask the patient to blink and
hold their fixation for about 3 seconds.

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13. Click the green checked mark on the bottom of the software screen or the button on the
joystick to start the acquisition. You will see the progress bar below the IR image fill up
as shown in the example below. Also, the yellow arrow on the top right of the OCT
image window will show a vertical arrow to indicate the vertical raster scan (FastY) is
being performed.

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14. After the completion of the FastY (vertical raster) scan, the program will prompt the
operator to “Continue and Save” to go ahead and perform the Motion Correction
Technology (MCT) routine and save the result, “Rescan” the FastY scan, or “Cancel” the
entire acquisition session. At this point, the program will show the Angio FastY image
(without motion correction) on the top left box above the IR image. The thin vertical
white lines in this Angio image indicate eye motion or saccades that took place during
this FastY acquisition. The operator should determine whether to “Rescan” the FastY
scan if there are any blinks or excessive motion in the FastY dataset. At this point, the
subject is done with the Angio acquisition and can relax and/or close their eyes.

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15. In this example below, the subject blinked right into middle of the FastY acquisition. The
blink shows up in the Angio FastY image as a vertical band of black strip in the middle of
the image. In this case, the operator should choose the Rescan the FastY dataset.

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16. After selecting “Continue and Save” button, the program will prompt the operator to
perform the Motion Correction Technology (MCT) routine and save the result. At this
point, the program will show the Angio-OCT image (with motion correction) on the top
left box above the IR image. The operator should assess the performance of the MCT to
remove all the white line artifacts caused by eye motion and saccades. If the result of
this Angio Disc image is not satisfactory, another scan can be performed immediately
without having to evaluate the previous scan in the Review screens.

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