Analysis of macular microvasculature with optical coherence tomography angiography for migraine: A systematic review and meta-analysis

Abstract

ObjectiveThis study aimed to evaluate the features of macular microvasculature with optical coherence tomography angiography (OCTA) among migraine patients.MethodsWe systematically searched PubMed, Web of Science, Embase, and Cochrane Library for studies that evaluated the macular microvasculature of migraine patients. The weighted mean differences (WMDs) of the foveal avascular zone (FAZ), foveal superficial capillary plexus (SCP) vessel density (VD), parafoveal SCP VD, foveal deep capillary plexus (DCP) VD, and parafoveal DCP VD with 95% confidence intervals (CIs) among migraine with aura (MA) group, migraine without aura (MO) group, and healthy controls (HC) group were analyzed using a random-effect model. P < 0.05 was considered significant in statistical analyses. Publication bias was assessed using funnel plots and statistical tests (Egger's test and Begg's test).ResultsNine studies covering 675 individuals were enrolled in this meta-analysis ultimately. The FAZ of MA patients was not significantly different from HC (WMD = 0.04, 95% CI −0.00 to 0.09). However, the FAZ of MA was significantly larger than that of HC after correction of publication bias by trim and fill method (WMD = 1.03, 95% CI 0.99 to 1.08). The FAZ of MO patients was similar to that of HC (WMD = 0.03, 95% CI −0.00 to 0.07), while smaller than that of MA patients (WMD = 0.05, 95% CI 0.01 to 0.09). VD of the SCP, either in the foveal or parafoveal area, was not significantly different among the three groups. As for DCP, VD in MA patients was lower when compared with HC in the parafovea (WMD = −1.20, 95% CI −1.88 to −0.51).ConclusionsWe found that there was a larger FAZ in MA compared with HC after adjusting for publication bias. The FAZ in MO was not significantly different from that in HC, but significantly lower than that in MA. There was no significant difference in either foveal or parafoveal VD of SCP among MA, MO, and HC participants, while the parafoveal VD of the DCP in MA was lower than that of the HC.

Reduction in retinal microvascular perfusion during migraine attacks

“…Based on a recent meta-analysis of OCTA in migraine, alteration of the FAZ, specifically enlargement of the FAZ area in MA has been the most consistently reported change seen in OCTA studies. 55 Our study showed changes in the shape of the FAZ described by the circularity in MA versus MO, and although the FAZ area was larger in MA in our study, this size difference did not reach statistical significance. Here, we also note that there is a large variation in FAZ size in normal individuals that has been reported in literature based on age, 65,66 sex, 65,67 ethnic backgrounds, 68 axial length of the eye, 69,70 segmentation method, 70 and OCTA machines.…”

“…The MA fovea showed an altered architecture of the FAZ, as well as a reduction in the interictal perfusion of the fovea (reduced VFI), when compared to the MO group. Based on a recent meta‐analysis of OCTA in migraine, alteration of the FAZ, specifically enlargement of the FAZ area in MA has been the most consistently reported change seen in OCTA studies 55 . Our study showed changes in the shape of the FAZ described by the circularity in MA versus MO, and although the FAZ area was larger in MA in our study, this size difference did not reach statistical significance.…”

“…To date there have been limited studies evaluating the macular microvasculature using OCTA in the interictal [38][39][40][41][54][55][56][57][58][59][60] and especially the ictal [61][62][63] phase of migraine. Our study examined both the interictal and ictal phase in a cohort of participants with high-frequency MA and MO, enabling investigation of the effect of a migraine attack on retinal vasculature and blood flow while accounting for the interictal baseline.…”

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

“…These observations may indicate an association between aura and ischemia (Ke et al, 2022). The larger FAZ may indicate permanent changes due to the recurrent retinal capillary ischemia causing chronic capillary ischemia or remodeling (McKendrick and Nguyen, 2022;Pang et al, 2023).…”

“…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).…”