Retinal microvasculature features in patients with migraine: a systematic review and meta-analysis

Abstract

BackgroundMigraine is a central nervous system disorder involving neuronal and vascular factors. The brain has a close anatomical relationship with retinal vessels and similar regulatory processes, and the retinal vascular system is the only in vivo vessel that can be directly visualized, while optical coherence tomography angiography (OCTA) is an advanced retinal vascular imaging technique. In this study, OCTA was used to study the retinal vascular density (VD) and foveal avascular zone (FAZ) in migraine patients, which provided a theoretical basis for its use as a candidate for rapid and non-invasive diagnosis of migraine.MethodsPublished studies comparing retinal microvascular profiles between migraine patients and healthy controls were obtained by a comprehensive search of electronic databases. Nine studies were finally included, including 775 eyes (migraine group: 444 eyes, control group: 331 eyes). Pooled effect sizes were presented as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager software (version 5.30).ResultsThe combined results revealed that the superficial and deep macular whole enface VD (MWEVD) (superficial VD: SMD = −0.30, P = 0.0001; deep VD: SMD = −0.61, P = 0.02), superficial foveal VD (FVD) (SMD = −0.42, P = 0.03), deep parafoveal VD (PFVD) (SMD = −0.31, P = 0.002), and peripapillary VD (PVD) (SMD = −0.49, P = 0.002) were significantly reduced in migraine patients compared with healthy people. However, there was a significant increase in the area of the FAZ in migraine patients (SMD = 0.56, P < 0.0001).ConclusionMigraine patients are prone to retinal microcirculation disorders, such as decreased blood vessel density and increased avascular area in the fovea. This provides a theoretical basis for OCTA as a candidate for rapid, non-invasive diagnosis of migraine.

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

“…In one study, investigators found no difference between those with and without WMH (Taşlı and Ersoy, 2020). Although deep foveal VD tended to be lower in migraineurs than controls, this was not significant-but this may be because of projection artifacts (Campbell et al, 2017) and the small number of studies analyzed (Pang et al, 2023). Chronic migraineurs had thinner macular RNFL and macular thickness than controls (Raga-Martínez et al, 2022).…”

“…The lack of blood vessels here serves to reduce light scattering and provide maximal optical quality at the point of ocular fixation on an object. Pang's meta-analysis of nine studies shows that migraineurs had a larger FAZ area than controls (Pang et al, 2023). Ke et al (2022) examined nine studies, where they found that the FAZ area of aura migraineurs was greater than controls after correcting for publication bias (Ke et al, 2022).…”

“…OCTA, on the other hand, provides a robust assessment of the retinal vasculature, and it can also discriminate between superficial and deep capillary plexus networks ( Magrath et al, 2017 ). OCTA can precisely show capillaries undergoing ischemia ( Pang et al, 2023 ). OCTA is superior to traditional methods for imaging radial pericapillary and deep capillary networks based on flow characteristics ( De Carlo et al, 2015 ; Spaide et al, 2015 ), and non-perfusion can therefore be quantified accurately ( Campbell et al, 2017 ) with a high data acquisition rate ( Huang et al, 1991 ).…”

“…Nowadays, OCTA is widely used in ophthalmology and cardiovascular disease as a powerful tool called an “optical biopsy” ( Brezinski et al, 1996 ; Tearney et al, 1997 ; Fujimoto et al, 2023 ). The retina is the only vasculature that can be visualized non-invasively in vivo ( Pang et al, 2023 ). We consider the eye as an extension of the brain because the optic nerve, retina, and brain derive from the anterior neural tube during embryonic development ( London et al, 2013 ).…”

“…Figure4shows an example of the central FAZ imaged via OCTA(Ghassemi et al, 2017). Pang's meta-analysis of nine studies shows that migraineurs had a larger FAZ area than controls(Pang et al, 2023) Ke et al (2022). examined nine studies, where they found that the FAZ area of aura migraineurs was greater than controls after correcting for publication bias(Ke et al, 2022).…”