Retina and microvascular alterations in migraine: a systemic review and meta-analysis

Abstract

ObjectiveThis study aimed to evaluate the retina and microvascular alterations with optical coherence tomography (OCT) or optical coherence tomography angiography (OCTA) in patients with migraine with aura (MA) and migraine without aura (MO).MethodsPubMed, Embase, and Cochrane Library databases were searched to find relevant literature on patients with MA or MO using OCT/OCTA devices. The eligible data were analyzed by Stata Software (version 15.0).ResultsThere were 16 studies identified, involving 379 eyes with MA, 583 eyes with MO, and 658 eyes of healthy controls. The thickness of the peripapillary retinal nerve fiber layer (pRNFL) of patients with MA decreased significantly in most regions. The foveal avascular zone (FAZ) area and perimeter in MA patients significantly enlarged, while the perfusion density (PD) in the macular deep capillary plexus (mDCP) significantly decreased in the whole image and its subregions except for the fovea, with the PD in radial peripapillary capillary (RPC) decreasing inside the disk. Patients with MO demonstrated a significantly decreased thickness of pRNFL in most regions, and the FAZ parameters were significantly enlarged. No statistical significance was observed in the retina and microvascular features of patients with MA and MO.ConclusionThe eyes affected by MA and MO demonstrated significantly reduced thickness of pRNFL and enlarged FAZ. Patients with MA showed retinal microvascular impairments, including a decreased PD in mDCP. The OCT and OCTA could detect membrane morphology and circulation status in migraine and might provide the basis for the diagnosis and follow-up of patients with migraine.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, CRD42023397653.

Using optical coherence tomography and optical coherence tomography angiography to delineate neurovascular homeostasis in migraine: a review

“…The changes in aura migraineurs were more severe. Aura migraineurs had thinner maculae and lower VD than non-aura migraineurs and controls (Cankaya and Tecellioglu, 2016;Chang et al, 2017;Ao et al, 2019;Karahan et al, 2021;Liu et al, 2023). In the deep capillary plexus, the VD in aura migraineurs was lower in the parafovea than in controls (Ke et al, 2022), but the measurement of the parafoveal ring differs from study to study (Ke et al, 2022).…”

“…This suggests greater increased energy demand at the retina in chronic migraineurs. Unsurprisingly, migraineurs, especially those with aura, seem to have retinal capillary damage ( Liu et al, 2023 ).…”

“…During migraine attacks and/or auras, transient vasospasm can compromise perfusion in both the eye and head ( Liu et al, 2023 ). This can change retinal/neuronal perfusion, in turn causing hypoxic/ischemic injury, ultimately damaging the retinal nerve ( Liu et al, 2023 ) and structures.…”

“…During migraine attacks and/or auras, transient vasospasm can compromise perfusion in both the eye and head ( Liu et al, 2023 ). This can change retinal/neuronal perfusion, in turn causing hypoxic/ischemic injury, ultimately damaging the retinal nerve ( Liu et al, 2023 ) and structures. Lower deep retinal VD is correlated with lower signal strength index, longer axial length, and higher creatinine, where creatinine acts as an energy buffer for retinal cells ( Tachikawa et al, 2007 ; You et al, 2019 ).…”

“…Migraineurs, especially those with aura, tend to have optic nerve head damage ( Liu et al, 2023 ). Migraineurs had smaller optic and neuroretinal rim disc areas, a lower cup-disc ratio at the optic nerve head, greater disc area, and larger cup volumes than controls ( Khosravi et al, 2018 ; Yener and Yılmaz, 2020 ).…”