Optometric function in visually sensitive migraine before and after treatment with tinted spectacles

Abstract

Optometrists frequently encounter patients with migraine and patients and practitioners sometimes suspect that visual stimuli or visual anomalies trigger headaches. There is a lack of evidence-based research on the issue, however. Some patients with migraine may be hypersensitive to visual stimuli, and it has been suggested that individually prescribed coloured filters might be an effective treatment to reduce symptoms from such stimuli. A recent randomised controlled trial showed such a treatment to be effective and the present paper reports on the optometric characteristics of the patients in this study. Twenty-one patients with neurologically diagnosed migraine were compared with 11 controls. No significant differences were found between the two groups with respect to refractive error, ocular pathology, colour vision, contrast sensitivity, accommodative function, strabismus and hyperphoria. The migraine group tended to be a little more exophoric, but by most criteria they were able to compensate for their exophoria as well as the control group. The migraine group were more prone to pattern glare than the controls (p = 0.004). The effects of precision tinted and control tinted lenses were investigated. The only variable to show a consistent and marked improvement with tinted lenses was pattern glare. The most likely mechanism for the benefit from individually prescribed coloured filters in migraine is the alleviation of cortical hyperexcitability (Wilkins et al. 1994) and associated pattern glare.

The optometric correlates of migraine

“…This review did not relate specifically to migraine, so will not be described in detail. Evans et al (2002), in a study described in the next section, found no significant difference between a group of migraine and a group of control patients in the subjective refractive error or in the proportion of participants who wore spectacles.…”

“…They therefore did not represent a ÔnormalÕ group of migraine sufferers. Evans et al (2002) did find using one test method, that the migraine group tended to have a marginally decompensated exophoria at near; however, other test methods suggested that the migraine group were as able to compensate for their exophoria as the control group.…”

“…However, Sucher's study did not look at the effect of treatment. Evans et al (2002) compared 21 migraine sufferers to 11 controls and found no difference between the groups in relation to strabismus or hyperphoria. The main purpose of this study was to investigate the effect of coloured filters , so the migraine sufferers were selected as those who found a coloured filter to be helpful.…”

“…They showed with headache diaries that headache frequency was significantly lower when a precise optimal tint was worn when compared with a suboptimal tint used as a control. The group was a selected group of migraine sufferers that found colour helpful and their optometric characteristics were described by Evans et al (2002). Evans et al (2002) showed that pattern glare symptoms of visual stress were reduced with a precisely selected colour of tinted spectacles.…”

“…The group was a selected group of migraine sufferers that found colour helpful and their optometric characteristics were described by Evans et al (2002). Evans et al (2002) showed that pattern glare symptoms of visual stress were reduced with a precisely selected colour of tinted spectacles. However, this reduction in visual stress was not significantly different from that produced by only a slightly different tint that was used as a control.…”