Retinal vascular density evaluation of migraine patients with and without aura and association with white matter hyperintensities

Evaluation of macular and peripapillary structure and microvasculature with optical coherence tomography angiography in migraine in the Indian population

BACKGROUND

Migraine has been proposed as a potential contributing factor to ischemic complications involving the retina and optic nerve. Ophthalmic disorders connected with migraine encompass occlusions of the branch and central retinal arteries and veins, alongside anterior and posterior ischemic optic neuropathy. With the advent of optical coherence tomography angiography (OCTA), it is easy to identify these macular subclinical microvascular and structural changes.

AIM

To evaluate macular and peripapillary structural and microvasculature changes in patients with migraine with aura (MA), migraine without aura (MW), and healthy control (HC) participants using OCTA.

METHODS

In this observational cross-sectional study, we studied a total of 100 eyes: (1) 32 eyes of 16 patients with MA; (2) 36 eyes of 18 patients with MW, recruited based on the International Classification of Headache Disorders; and (3) 32 eyes of 16 age and sex-matched healthy participants. Foveal flux, foveal avascular zone (FAZ), peripapillary flux obtained from OCTA, and foveal and peripapillary ganglion cell layer (GCL) thickness calculated via optical coherence tomography were compared among the groups.

RESULTS

The mean FAZ area measured in patients with MA and MW was significantly larger than that in the control participants (P = 0.002). However, there was no significant difference between the FAZ of the MA and MW groups. Macular perfusion in the superficial capillary plexus in patients with MA was significantly lower compared to MW (P = 0.0018) and HCs (P = 0.002). There was also significant thinning of the GCL in patients with MA and MW (P = 0.001) compared to HCs. However, there was no significant difference in temporal GCL thickness between the MA and MW groups.

CONCLUSION

Significant changes have been found in structural and microvascular parameters in patients with migraines compared with HCs. OCTA can serve as a valuable non-invasive imaging technique for identifying microcirculatory disturbances, aiding in better understanding the pathogenesis of different types of migraine and establishing their link with other ischemic retinal and systemic pathologies.

Decrement of choroid vascularization during spontaneous migraine attacks: An optical coherence tomography angiography study

OBJECTIVE

This study aimed to analyze the microcirculation of the macula, the optic nerve, and the choroid in patients with migraine by optical coherence tomography angiography (OCTA) during spontaneous migraine attacks, comparing the findings with scans performed in the interictal period in the same subjects and healthy controls (HCs).

METHODS

In this case-crossover design study, patients diagnosed with migraine who underwent an OCTA during a migraine attack were enrolled. A cohort of HCs was recruited for comparison. Data from ocular and orthotic examinations and clinical and demographical information were collected. All subjects were imaged with Solix full range OCT, recording the following parameters: macular vessel density (VD), inside disc VD, peripapillary VD, disc whole image VD, fovea choriocapillaris VD, fovea VD, parafovea VD, peripapillary thickness, fovea thickness, parafovea thickness, macular full retinal thickness, and foveal avascular zone (FAZ).

RESULTS

Thirteen patients (26 eyes individually assessed) with a diagnosis of migraine were included (9 without aura [69.2%] and 4 with aura [30.7%], with a mean age of 25.2 ± 3.4 years) and scanned during the ictal and interictal phase. Fifteen age-matched HCs (30 eyes individually assessed) were included. The foveal choriocapillaris VD was significantly lower in the ictal phase (63.3 ± 2.47%) compared to the interictal phase in the same patients (64.9 ± 2.79%) (p = 0.0019). Comparing the ictal scans from migraine patients and HCs, the FAZ area was significantly larger, and the inside disc, fovea, and fovea choriocapillaris VDs were significantly lower.

CONCLUSION

The study demonstrated a dynamic decrement in choroidal vascularization in migraine patients during spontaneous migraine attacks.

Evaluation of retinal perfusion density and foveal avascular zone in migraine subjects with and without aura

Migraine, classified as a neurovascular disease, has been identified as a potential risk factor for ocular vascular complications. Our study aimed to compare retinal vessel density and perfusion density between subjects with migraine and healthy subjects using optical coherence tomography angiography (OCTA). In this cross-sectional case-control study, we enrolled 30 migraine subjects with aura (MWA), 30 migraine subjects without aura (MWOA) and 30 age and gender-matched healthy controls (HC). The foveal avascular zone (FAZ) in superficial capillary plexus (SCP), Vessel density (VD) and perfusion density (PD) in SCP and deep capillary plexus (DCP) were assessed in a 3 × 3 mm scan of the macula with the swept source OCT. Results indicated that the FAZ of MWA and MWOA subjects was significantly larger from HC. Also, FAZ of MWA was larger from MWOA. VD and PD in both SCP and DCP were significantly reduced in both MWA and MWOA groups compared to HC. However, VD and PD did not show significant differences among MWA and MWOA. Additionally, the duration of disease was the main determinant of the FAZ. In conclusion, the FAZ in the SCP, VD and PD in the SCP and DCP of the macula were affected in both MWA and MWOA. FAZ, specifically, was increased with the evolution of the disease. These findings might contribute to an increased risk of ocular vascular complications among subjects with migraine and could potentially use OCTA as a biomarker for this population.

Migraine eye: correlation between migraine and the retina

Background

Activation of the trigeminal vascular system in migraine releases vasoactive neurotransmitters, causing abnormal vasoconstriction, which may affect the ocular system, leading to retinal damage. The purpose of our study was to determine whether there are differences in each retinal layer between migraine patients and healthy subjects.

Methods

A case-control study recruited 38 migraine patients and 38 age- and sex-matched controls. Optical coherence tomography was used to measure the thickness of the peripapillary and macular retinal nerve fiber layer (pRNFL and mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer (INL).

Results

The mean ages of the migraine patients and controls were 36.29 ± 9.45 and 36.45 ± 9.27 years, respectively. Thirty-four patients (89.48%) in both groups were female. The mean disability score was 19.63 ± 20.44 (indicating severe disability). The superior-outer INL of migraine patients were thicker than controls. Thickness of the GCL at temporal-outer sector and mRNFL at the superior-outer sector of the headache-side eyes was reduced. However, the INL of the headache-side-eye showed negative correlation with the disability score. This is the first study having found thinning of the GCL and mRNFL of the headache-side eyes. The INL was also thickened in migraines but showed negative correlation with the disability score.

Conclusions

Increased INL thickness in migraine patients may result from inflammation. The more severe cases with a high disability score might suffered progressive retinal neuronal loss, resulting in thinner INL than less severe cases.

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

Migraine is one of the world's most debilitating disorders, and it has recently been shown that changes in the retina can be a potential biomarker for the disease. These changes can be detected by optical coherence tomography (OCT), which measures retinal thickness, and optical coherence tomography angiography (OCTA), which measures vessel density. We searched the databases Google Scholar, ProQuest, Scopus, and Web of Science for studies in English using OCT and OCTA in migraineurs, using the search terms "optical coherence tomography," "OCT," "optical coherence tomography angiography," "OCTA" and "migraine." We found 73 primary studies, 11 reviews, and 8 meta-analyses pertaining to OCT and OCTA findings in migraineurs. They showed that migraineurs had reduced retinal thickness (via OCT), retinal vessel density, and greater foveal avascular zone area (via OCTA) than controls. OCTA changes reflect a perfusion compromise occurring in migraineurs as opposed to in healthy controls. OCT and OCTA deficits were worse in migraine-with-aura and chronic migraine than in migraine-without-aura and episodic migraine. Certain areas of the eye, such as the fovea, may be more vulnerable to these perfusion changes than other parts. Direct comparison between study findings is difficult because of the heterogeneity between the studies in terms of both methodology and analysis. Moreover, as almost all case-control studies were cross-sectional, more longitudinal cohort studies are needed to determine cause and effect between migraine pathophysiology and OCT/OCTA findings. Current evidence suggests both OCT and OCTA may serve as retinal markers for migraineurs, and further research in this field will hopefully enable us to better understand the vascular changes associated with migraine, perhaps also providing a new diagnostic and therapeutic biomarker.

Optical Coherence Tomography Angiography: Revolutionizing Clinical Diagnostics and Treatment in Central Nervous System Disease

Optical coherence tomography angiography (OCTA), as a new generation of non-invasive and efficient fundus imaging technology, can provide non-invasive assessment of vascular lesions in the retina and choroid. In terms of anatomy and development, the retina is referred to as an extension of the central nervous system (CNS). CNS diseases are closely related to changes in fundus structure and blood vessels, and direct visualization of fundus structure and blood vessels provides an effective "window" for CNS research. This has important practical significance for identifying the characteristic changes of various CNS diseases on OCTA in the future, and plays a key role in promoting early screening, diagnosis, and monitoring of disease progression in CNS diseases. This article reviews relevant fundus studies by comparing and summarizing the unique advantages and existing limitations of OCTA in various CNS disease patients, in order to demonstrate the clinical significance of OCTA in the diagnosis and treatment of CNS diseases.

Reduction in retinal microvascular perfusion during migraine attacks

OBJECTIVE

To determine if there are changes in structure and function of the retinal vasculature during and between migraine attacks using optical coherence tomography angiography (OCTA).

BACKGROUND

Migraine attacks commonly include visual symptoms, but the potential role of the retina in these symptoms is not well understood. OCTA is a rapid, non-invasive imaging technique that is used to visualize the retinal microvasculature with high spatial resolution in a clinical setting. In this study we used OCTA to quantify different features of the retinal vasculature in patients with migraine during and between attacks, as well as in healthy controls (HCs).

METHODS

We performed a prospective cohort study of 37 patients with migraine with aura (MA) (median [interquartile range, IQR] age of 37 [14] years, 86% female) and 30 with migraine without aura (MO) (median [IQR] age of 37 [17] years, 77% female) and 20 HCs (median [IQR] age of 35 [7] years, 50% female). Macular OCTA scans were obtained for all participants for the interictal analysis. In 12 MA and eight MO, scans were captured both during and outside of migraine attacks and five HCs had initial and repeat scans. In addition to analyzing the morphology of the foveal avascular zone, we calculated the vessel flux index (VFI), which is an indicator of retinal perfusion and conventional metrics (such as vessel area density) in the foveal and parafoveal regions.

RESULTS

There was a significant difference in the parafoveal VFI in the ictal state between the groups (p = 0.009). During migraine attacks there was a significant reduction in the parafoveal region VFI in MA (-7%, 95% confidence interval [CI] -10% to -4%; p = 0.006) and MO (-7%, 95% CI -10% to -3%; p = 0.016) from their interictal baseline as compared to the change between repeat scans in HCs (2%, 95% CI -3% to 7%). Interictally, there was a mean (standard deviation [SD]) 13% (10%) (p = 0.003) lower blood perfusion in the MA group as compared to the MO group in the foveal region (mean [SD] 0.093 [0.023] vs. 0.107 [0.021], p = 0.003). Interictal analysis also revealed higher circularity in the superficial foveal avascular zone in the MA group compared with the MO group (mean [SD] 0.686 [0.088] vs. 0.629 [0.120], p = 0.004). In addition, interictal analysis of the patients with MA or MO and unilateral headache showed increased retinal vascular parameters consistent with greater perfusion in the eye ipsilateral to the side of the pain as compared with the contralateral eye.

CONCLUSIONS

These results indicate that perfusion is reduced in MA and MO in the parafoveal retina during the ictal period. Interictally, the foveal retina in MA has reduced perfusion when compared to the foveal retina in MO. Patients with unilateral headache showed interictal asymmetry of retinal perfusion between eyes. These results indicate that changes in retinal perfusion could be a part of migraine pathophysiology, and that distinct retinal vascular signatures identified with OCTA could represent biomarkers for migraine.

Retinal and peripapillary vascular density in episodic and chronic migraine cases without aura

BACKGROUND

Migraine is a neurovascular disease that can cause ocular and systemic ischemic damage. Despite from aura, a limited number of studies have considered the effect of the chronic migraine in cases without aura. Our aim was to evaluate the differences in the retinal and optic disk microvasculature among episodic and chronic migraine cases without aura using optical coherence tomography angiography (OCTA) imaging.

METHODS

45 cases with migraine, and 25 control subjects were included in this prospective, cross-sectional study. OCTA was performed at 3 × 3 mm and 6 × 6 mm of the macula and at 4.5 × 4.5 mm of the optic disk. Retinal nerve fiber layer (RNFL) thickness, ganglion cell complex thickness, and vessel densities of the optic nerve and macula were compared among the three groups: a control group, an episodic migraine without aura (EMWOA) group, and a chronic migraine without aura (CMWOA) group.

RESULTS

In EMWOA group, circumpapillary vascular density (cpVD) was not decreased significantly in any quadrants (all, p>0.05). Compared to the control group, CMWOA group had significantly lower RNFL thickness in superior-temporal quadrants (p = 0.002 and 0.006, respectively), while cpVD differed only in the temporal quadrant and temporal inferior sector (p = 0.002 and p = 0.009, respectively).

CONCLUSIONS

Temporal peripapillary perfusion is valuable in the follow-up of chronic migraine cases. Longitudinal studies are needed to determine the place of OCTA in the follow-up of migraine.

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

Objective

This 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).

Methods

PubMed, 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).

Results

There 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.

Conclusion

The 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 registration

https://www.crd.york.ac.uk/prospero/, CRD42023397653.

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

Background

Migraine 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.

Methods

Published 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).

Results

The 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).

Conclusion

Migraine 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.

Assessment of the Optic Disc and Retinal Microvasculature by Optical Coherence Tomography Angiography in Patients With Pediatric Migraine

BACKGROUND

Migraine, as a chronic neurovascular disease, is known to be a risk factor for retinal and optic nerve head damage. Herein, we aimed to evaluate the optic disc and retinal microvasculature in pediatric migraine (PM) patients using optical coherence tomography angiography (OCTA).

METHODS

Forty-six eyes of 23 patients with PM without aura (PM group) and 46 eyes of 23 age- and sex-matched healthy subjects (control group) were included in this cross-sectional prospective study. Demographic features and ophthalmological examination including OCTA measurements were evaluated. OCTA was performed with 6- × 6-mm sections for macula and 4.5- × 4.5-mm sections for optic nerve head in all eyes. Foveal retinal thickness (FRT), peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina, and optic disc were analyzed and compared between the groups. All measurements of the PM patients were taken in the attack-free period.

RESULTS

The mean ages of the PM group and control group were 11.17 ± 3.3 and 11.83 ± 2.8 years, respectively ( P = 0.479). Gender and mean intraocular pressures were similar between the groups. The mean central corneal thickness levels in the PM group were significantly lower than control group, 548.28 ± 26.3 µm and 562.04 ± 24.5 µm, respectively ( P = 0.011). There was no significant difference regarding average and all quadrant RNFL thicknesses, foveal avascular zone and flow areas, deep vessel densities, and optic disc capillary densities between the groups. However, compared with the control group, the PM group showed significant higher values of FRT, and lower values of superficial whole and parafoveal vessel densities (247.28 ± 15.8 µm vs 285.93 ± 11.1, P < 0.001, 51.85 ± 2.4% vs 50.31 ± 4.0%, P = 0.02, 55.09 ± 2.3% vs 53.5 ± 3.5%, P = 0.01, respectively). Disease duration and attacks/year did not show any significant correlations with OCTA values.

CONCLUSIONS

PM seems to be associated with lower superficial whole and parafoveal vessel densities because of hypoperfusion and ischemia. OCTA may be suggested for use in follow-up and management of PM patients.

Microvascular involvement in migraine: an optical coherence tomography angiography study

OBJECTIVE

The aim of this study was to evaluate the microvasculature of the macula and the optic nerve in patients affected by migraine with aura (MA) and without aura (MO) by optical coherence tomography angiography (OCTA), comparing the findings with healthy controls (HC).

METHODS

We collected data from ocular and orthotic examinations, including eye motility, intraocular pressure measurement, best-corrected visual acuity (BCVA) measurement, objective refraction measurement, fundus examination, macular and optic disk OCTA examination. All subjects were imaged with solix fullrange OCT. The following OCTA parameters were recorded: macular vessel density (VD), inside disc VD, peripapillary VD, disc whole image VD, fovea choriocapillaris VD, fovea VD, parafovea VD, peripapillary thickness, fovea thickness, parafovea thickness, macular full retinal thickness, and foveal avascular zone (FAZ) parameters. Clinical and demographical data about migraine patients were collected by a neurologist.

RESULTS

We included 56 eyes from 28 patients with a diagnosis of MO, 32 eyes from 16 patients with a diagnosis of MA, and 32 eyes from 16 HC subjects. The FAZ area was 0.230 ± 0.099 mm² in the MO group, 0.248 ± 0.091 mm² in the MA group and 0.184 ± 0.061 mm² in the control group. The FAZ area was significantly larger in the MA group than in the HC group (p = 0.007). The foveal choriocapillaris VD was significantly lower in MA patients (63.6 ± 2.49%) when compared with MO patients (65.27 ± 3.29%) (p = 0.02).

CONCLUSION

An impairment of retinal microcirculation can be detected in patients with MA, as demonstrated by the enlargement of FAZ. Moreover, the study of choroid circulation may reveal microvascular damage in patients with migraine with aura. OCTA is a useful non-invasive screening tool for the detection of microcirculatory disturbance in patients with migraine.

L-arginine and aged garlic extract for the prevention of migraine: a study protocol for a randomised, double-blind, placebo-controlled, phase-II trial (LARGE trial)

Background

Migraine is a common and distressing neurological condition characterised by recurrent throbbing headaches, nausea and heightened sensitivity to light and sound. Accumulating evidence suggests that cerebral arteries dilate during migraine, causing distal microvessels to constrict, which could activate nociceptors and cause onset of headache pain. If so, preventing or attenuating chronic microvascular constriction, and promoting a dilatory phenotype, may reduce frequency and/or severity of migraines. The primary aim of the L-Arginine and Aged Garlic Extract (LARGE) trial is to investigate whether oral treatment with dietary nutraceuticals, L-arginine and aged garlic extract (AGE), both systemic vasodilatory agents, will alleviate migraine frequency, duration and severity in adults with chronic frequent episodic migraines.

Methods

The study is a randomised double-blind placebo-controlled phase-II single-site clinical trial conducted in Perth, Australia. The target sample is to recruit 240 participants diagnosed with chronic frequent episodic migraines between 18 and 80 years of age. Participants will be randomised to one of four treatment groups for 14 weeks (placebo induction for 2 weeks, followed by 12 weeks on one of the respective treatment arms): placebo, L-arginine, AGE, or a combination of L-arginine and AGE. The doses of L-arginine and AGE are 1.5 g and 1 g daily, respectively. The primary outcome is to assess migraine response using change in migraine frequency and intensity between baseline and 12 weeks. Secondary outcomes include the impact of L-arginine and/or AGE on photosensitivity, retinal vessel changes, and blood biomarker concentrations of vascular tone, following a 12-week intervention.

Discussion

The protocol describes the oral administration of 2 nutraceutical-based interventions as possible prophylactic treatments for chronic frequent episodic migraines, with potential for direct clinical translation of outcomes. Potential limitations of the study include the fixed-dose design of each treatment arm and that in vivo neuroimaging methods, such as magnetic resonance imaging (MRI), will not be conducted to determine putative cerebro-vasodilatory changes to coincide with the outcome measures. Dose-response studies may be indicated.

Trial registration

The trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12621001476820 (Universal Trial Number: U1111-1268-1117) on 04/08/2021. This is protocol version 1, submitted on 25/11/2022.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-023-03149-y.

Evaluation of retinal vessel and perfusion density in migraine patients by optical coherence tomography angiography

BACKGROUND

Migraine is a neurovascular disease and has been reported as a risk factor for ocular vascular complications. Our study aimed to compare the retinal vessel density and perfusion density between migraine patients and healthy subjects by optical coherence tomography angiography (OCTA).

METHODS

In this prospective study, 23 patients with migraine with aura (MWA) and 31 patients with migraine without aura (MWOA), and 32 age- and gender-matched healthy controls (HC) were enrolled. The vessel density (VD) and perfusion density (PD) were evaluated in a 6 × 6 mm scan of the macula and optic nerve head (ONH) with the Cirrus HD-OCT 5000 device. The measurement area is divided into three areas: center (c), inner ring (ir), outer ring (or) (with diameters of 1, 3, and 6 mm respectively), and nine subfields, according to the Early Treatment Retinopathy Study grid.

RESULTS

The macular cVD, cPD, and temporal orVD in MWA and MWOA groups were significantly reduced than those of HC. On optic nerve head OCTA, patients with MWA had decreased cVD, average irVD, inferior irVD, and temporal orVD compared with HCs while MWOA had reduced cVD than HC group. In addition, PD was not significantly different among MWA, MWOA, and HC groups in any measure in the optic nerve head. The Migraine Disability Assessment Score (MIDAS) and attack frequency were significantly inversely correlated with cVD, cPD, irVD, and irPD of macula and ONH.

CONCLUSIONS

Vessel and perfusion density of macula were reduced in both MWA and MWOA. Vessel density, but not perfusion density of ONH was decreased in MWA. The migraine severity and attack frequency were significantly inversely correlated with vessel and perfusion density of macula and ONH.

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

Objective

This study aimed to evaluate the features of macular microvasculature with optical coherence tomography angiography (OCTA) among migraine patients.

Methods

We 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).

Results

Nine 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).

Conclusions

We 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.

Evaluation of retinal microvasculature and foveal avascular zone by the optical coherence tomography angiography in pediatric migraine patients

To compare the foveal avascular zone (FAZ), macular and peripapillary vessel density and retinal nerve fiber layer (RNFL) thickness between pediatric migraine patients and healthy subjects. A total of 108 eyes of 54 children with migraine without aura and 94 eyes of 47 age- and gender-matched healthy subjects were included. Capillary vessel density (CVD) in superficial (SCP) and deep (DCP) retinal capillary plexus, peripapillary region, FAZ, and RNFL thickness were analyzed by optical coherence tomography-angiography. The mean ages were 12.4 ± 3.3 years (range 6-18) in patients with migraine and 12.6 ± 2.9 years (range 5-18) in healthy controls (p = 0.742). The mean FAZ area measured 0.27 ± 0.09 mm² in the pediatric migraineurs and 0.26 ± 0.09 mm² in healthy controls (p = 0.53). There was no significant difference in any measurement of SCP, DCP, peripapillary CVD, and RNFL thickness between study groups (p > 0.05 for all). The pediatric migraine disability assessment test (PedMIDAS) negatively correlated with some of the CVD and RNFL measurements in pediatric migraine patients (p < 0.05). The macular and peripapillary microvasculature were not significantly different during an attack-free period in pediatric migraine patients than in healthy subjects.

The eye in migraine: a review of retinal imaging findings in migraine

Migraine is a common headache disorder with neurovascular involvement. Because eyecare practitioners are likely to encounter people with migraine in their everyday practice, it is important to understand how migraine might impact on ocular health. In this narrative review, we provide an update on the latest ophthalmic imaging evidence for retinal involvement in migraine, derived from studies of retinal structure and retinal vascular perfusion using spectral domain and swept source optical coherence tomography (OCT) and OCT angiography. Combined structural OCT evidence from a recent meta-analysis indicates subtle and non-specific thinning of the peripapillary retinal nerve fibre layer (RNFL) in people with migraine, whereas there is little consistent evidence for structural abnormalities of the macular region. Recent advances in OCT angiography technology have also provided an opportunity to visualise microstructural damage and vascular dysregulation in the eyes of people with migraine. However, given that OCT and OCT angiography studies have been exclusively cross-sectional, it is not possible to demonstrate the causal effect of migraine events. Furthermore, the lack of common methodology (different ophthalmic imaging devices and analysis algorithms), and very limited datasets (small samples, heterogenous migraine groups), lead to an inability to make strong conclusions regarding the nature of altered retinal structure and vascular perfusion in migraine. Nevertheless, we discuss the clinical implications of such observations for eyecare practitioners and provide practical advice for the monitoring and management of patients with a history of migraine.

Choroidal vascularity index and retinal nerve fiber layer reflectivity in newly diagnosed migraine patients

PURPOSE

To evaluate the choroidal structural parameters, peripapillary retinal nerve fiber layer (RNFL) thickness, and optic density index (ODI) and their correlations in patients with migraine.

METHODS

Twenty-eight newly diagnosed migraine patients and 28 age-matched healthy controls were included in this prospective cross-sectional study. The enhanced depth-optical coherence tomography images were evaluated. The choroidal area (CA) was binarized to the luminal area (LA) and stromal area (SA) using Image J. The choroidal vascularity index (CVI), the mean peripapillary RNFL thickness, superior-inferior-nasal-temporal quadrant RNFL thicknesses, and the ODI were compared statistically.

RESULTS

The difference in the mean CVI between the patient group and controls reached a statistical significance (p=0.035). The mean RNFL thickness was significantly decreased in patients with migraine compared with the controls (p=0.040). The mean RNFL thickness in the superior, temporal, and inferior quadrants was significantly decreased in the patient group in comparison to the control subjects (p=0.030, p=0.001, and p=0.022, respectively). There were no significant differences between the migraine group and the controls for the mean ODI of RNFL (p=0.399).

CONCLUSION

The CVI and the RNFL thickness except for the nasal quadrant were significantly decreased in newly diagnosed migraine patients.

Is ocular vascularity affected in young migraine patients? A pilot study

OBJECTIVE

This study aimed to evaluate ocular vascularity in young adult migraine patients with visual aura and without visual aura.

MATERIAL AND METHODS

The study included 30 patients with migraine with visual aura (MWVA), 30 patients with migraine without visual aura (MWOVA), and 30 healthy control subjects, all between ages ≥18 and <45. Migraine patients were applied Headache Impact Test (HIT) and Migraine Disability Assessment Scale (MIDAS). Retinal nerve fiber layer thickness and ocular vascularity of all participants were evaluated with optical coherence tomography (OCT) and OCT angiography (OCTA).

RESULTS

The MWVA group had significantly lower superficial and deep foveal vascular density values compared to the control group (p = 0.039, p = 0.028, respectively). The foveal avascular zone was significantly enlarged in the MWVA group compared to the control group (p = 0.033). MWVA patients had significantly lower whole optic disc, optic disc inside, peripapillary, superior hemisphere, inferior hemisphere, superior quadrant, and temporal quadrant vascular density values compared to the control group (p < 0.05 all), while there was no significant difference in the nasal quadrant (p = 0.083). Migraine attack frequency, MIDAS, and HIT were negatively correlated with ocular vascular density values.

CONCLUSION

The results of our study indicate that young adult patients with MWVA are at risk of decreased ocular vascularity and that this risk may increase with frequency and severity of migraine attacks.

Evaluation of retinal and optic nerve vasculature by optic coherence tomography angiography in Migraine with Aura

PURPOSE

This study aimed to evaluate the retina by optic coherence tomography angiography (OCTA) in patients with migraine with aura (MA) in comparison with healthy controls.

MATERIALS AND METHODS

A total of 60 patients with MA and 56 control subjects who applied to the Ophthalmology Clinic of Dicle University between January 2020 and February 2020 were included in this study. In all patients, the vascular density (VD) of the radial peripapillary capillaries (RPCs) and optic nerve head (ONH), the VD of deep and superficial macular vascular networks, and foveal avascular zone (FAZ) were measured.

RESULTS

Patients with MA showed reduced VD measurements of the nasal and inferotemporal ONH, inferonasal RPCs, and deep macular plexus. No statistically significant difference was observed in the superficial macular VD values between the study groups. The majority of patients with MA showed hypertrophy in the deep FAZ.

CONCLUSION

There was a decrease in VD measurements in the deep macular capillary plexus, ONH, and peripapillary capillaries and hypertrophy in the deep FAZ in patients with MA. According to these results, patients with MA may have an increased risk of developing ocular and systemic vascular complications. Therefore, OCTA can be used to evaluate systemic and ocular hypoperfusion in patients with MA.

Evaluation of migraine patients with optical coherence tomography angiography

PURPOSE

To compare optical coherence tomography angiography (OCTA) findings in cases with migraine and healthy controls.

METHODS

Thirty-eight eyes of 19 patients with migraine with aura and 38 eyes of 19 healthy subjects were enrolled in this prospective and comparative study. All patients and healthy controls were evaluated with OCTA (Triton, Topcon®, Tokyo, Japan). Central macular thickness (CMT), optic disc parameters (such as retinal nerve fibre layer [RNFL] thickness and rim and disc areas), foveal avascular zone (FAZ) and parafoveal superficial vessel density (VD) measurements were analysed.

RESULTS

The optic disc rim area was significantly larger in the migraine group compared to the control group (p = 0.009). In OCTA measurements, the FAZ area was significantly larger in migraine patients (p = 0.001). The parafoveal superficial VD measurements were found to be lower in the migraine patients in all quadrants, but not statistically significant. Weak negative correlations were found between superior parafoveal VD and disease duration in migraine patients.

CONCLUSION

Migraine with aura was associated with optic disc rim changes, but without any remarkable foveal vascular decrements. It is possible for migraine to cause structural changes due to its chronic nature.

Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by Carotid Artery Stenosis

Purpose

Using retinal optical coherence tomography angiography (OCTA), we aimed to investigate the changes in important indicators of cerebral microcirculatory disorders, such as the properties of the radial peripapillary capillaries, vascular complexes, and the retinal nerve fiber layer, caused by carotid stenosis and postoperative reperfusion.

Methods

In this prospective longitudinal cohort study, we recruited 40 carotid stenosis patients and 89 healthy volunteers in the First Affiliated Hospital of Harbin Medical University (Harbin, China). Eyes with ipsilateral carotid stenosis constituted the experimental group, while the fellow eyes constituted the contralateral eye group. Digital subtraction angiography, CT perfusion imaging (CTP), and OCTA examinations were performed in all subjects. The vessel density of the radial peripapillary capillaries (RPC), superficial retinal vascular complexes (SVC), deep vascular complexes (DVC), choriocapillaris (CC), and the thickness of the retinal nerve fiber layer (RNFL) were assessed. Propensity-matched analysis was undertaken to adjust for covariate imbalances. Intergroup comparative analysis was conducted, and the paired sample t-test was used to evaluate the preoperative and postoperative changes in OCTA variables.

Results

The ocular vessel density in the experimental group was significantly lower than that in the control group (RPC: 55.95 vs. 57.24, P = 0.0161; SVC: 48.65 vs. 52.22, P = 0.0006; DVC: 49.65 vs. 57.50, P < 0.0001). Participants with severe carotid stenosis have reduced contralateral ocular vessel density (RPC 54.30; SVC 48.50; DVC 50.80). Unilateral stenosis removal resulted in an increase in vessel density on both sides, which was detected by OCTA on the 4^th day (RPC, P < 0.0001; SVC, P = 0.0104; DVC, P = 0.0104). Moreover, the ocular perfusion was consistent with that established by CTP.

Conclusion

OCTA can be used for sensitive detection and accurate evaluation of decreased ocular perfusion caused by carotid stenosis and may thus have the potential for application in noninvasive detection of cerebral microcirculation disorders. This trial is registered with NCT04326842.

Assessment of the choroidal thickness, central macular vascular and optic disk perfusion in migraine patients with optical coherence tomography angiography

BACKGROUND

Comparing the central choroidal thickness (CCT) and the perfusion of the macula and optic disk in patients with migraine and control group participants using optical coherence tomography angiography (OCTA).

METHODS

A total of 38 patients diagnosed with migraine and 32 healthy controls were recruited. OCTA scans were performed on all participants. Optic disk, central macular vascular perfusions, and CCT were measured.

RESULTS

Thirty-eight eyes of 38 participants (34 female and 4 male) in the migraine group and 32 eyes of 32 participants (19 female and 13 male) in the healthy control (HC) group were evaluated. The mean age was 42.74 ± 8.14 and 43.09 ± 14.28 years in the migraine group and HC group, respectively. The mean CCT were 314 ± 103 μm and 301 ± 71 μm in the migraine and HC group, respectively (p = 0.54). The mean optic disk perfusions were 44.77 ± 1.93% and 45.25 ± 1.43% in migraine and HC group, respectively (p = 0.25). The mean central macular vascular perfusions were 20.50 ± 8.20% and 18.65 ± 7.46% in migraine and HC group, respectively (p = 0.32). There was a significant negative correlation between CCT and the duration of migraine history (p = 0.004).

CONCLUSIONS

The macular and peripapillary microvasculature were not significantly different in patients with migraine than in HC. As the duration of migraine prolonged, a significant decrease in choroidal thickness was observed.

Retinal nerve fiber layer changes in migraine: a systematic review and meta-analysis

BACKGROUND

Migraine is one of the most common disabling diseases in the world. Its recurrent attacks may lead to abnormalities in the structure of the brain and retina. An increasing number of studies have investigated retinal nerve fiber layer (RNFL) thickness alterations in migraine by the optical coherence tomography (OCT); however, no consensus has yet reached.

METHOD

We searched Pubmed, Embase, and Web of Science databases to identify studies that investigated RNFL thickness in migraine by OCT measurement and performed a meta-analysis of eligible studies.

RESULTS

Twenty-six studies were included in the meta-analysis, comprising 1530 migraine patients and 1105 healthy controls. The mean RNFL thickness was thinner in the migraine group compared to the control group (SMD =- 0.53). In the subgroup analyses, RNFL thickness were decreased most significantly in the superior (SMD = - 0.71) and inferior (SMD = - 0.63) quadrants among all quadrants. Migraine with aura (SMD = - 0.91) showed a greater effect size of RNFL thickness reduction than migraine without aura (SMD =- 0.47). Spectral-domain OCT (SMD = - 0.55) seems more sensitive to detect RNFL thickness reduction than time-domain OCT (SMD = - 0.44). In addition, age, sex, disease duration, attack frequency, and intraocular pressure were not significantly associated with RNFL thickness.

CONCLUSIONS

The findings from our comprehensive meta-analysis with large datasets strengthen the clinical evidence of the RNFL thickness reduction in migraine. RNFL thickness via spectral-domain OCT measurement demonstrates the potential role in differentiating patients with migraine, especially migraine with aura, from healthy controls.

Optical Coherence Tomography Angiography in Neurodegenerative Diseases: A Review

Background

Optical coherence tomography angiography (OCT-A) has emerged as a novel, fast, safe and non-invasive imaging technique of analyzing the retinal and choroidal microvasculature in vivo. OCT-A captures multiple sequential B-scans performed repeatedly over a specific retinal area at high speed, thus enabling the composition of a vascular map with areas of contrast change (high flow zones) and areas of steady contrast (slow or no flow zones). It therefore provides unique insight into the exact retinal or choroidal layer and location at which abnormal blood flow develops. OCTA has evolved into a useful tool for understanding a number of retinal pathologies such as diabetic retinopathy, age-related macular degeneration, central serous chorioretinopathy, vascular occlusions, macular telangiectasia and choroidal neovascular membranes of other causes. OCT-A technology is also increasingly being used in the evaluation of optic disc perfusion and has been suggested as a valuable tool in the early detection of glaucomatous damage and monitoring progression.

Objective

To review the existing literature on the applications of optical coherence tomography angiography in neurodegenerative diseases.

Summary

A meticulous literature was performed until the present day. Google Scholar, PubMed, Mendeley search engines were used for this purpose. We used 123 published manuscripts as our references. OCT-A has been utilized so far to describe abnormalities in multiple sclerosis (MS), Alzheimer’s disease, arteritic and non-arteritic optic neuropathy (AION and NAION), Leber’s hereditary optic neuropathy (LHON) papilloedema, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis (ALS), Wolfram syndrome, migraines, lesions of the visual pathway and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). It appears that OCT-A findings correlate quite well with the severity of the aforementioned diseases. However, OCT-A has its own limitations, namely its lack of wide-field view of the peripheral retina and the inaccurate interpretation due to motion artifacts in uncooperative groups of patients (e.g. children). Larger prospective longitudinal studies will need to be conducted in order to eliminate the aforementioned limitations.

Structural and Microvascular Changes in the Macular Are Associated With Severity of White Matter Lesions

Purpose: This study aimed to characterize the microvascular and structural changes in the macular that occur in white matter hyperintensities (WMH) using optical coherence tomographic angiography. We also aimed to explore the association between macular microvascular and structural changes with focal markers of brain tissue on MRI in WMH using the Fazekas scale.

Methods: This study enrolled healthy participants who were stroke- and dementia-free. MRI was used to image the cerebral white matter lesions, and Fazekas scale was used to evaluate the severity of the white matter lesions. Optical coherence tomography angiography (OCT-A) was used to image the radial peripapillary capillaries (RPCs), macular capillary plexuses [superficial capillary plexus (SCP) and deep capillary plexus (DCP)] and thickness around the optic nerve head, peripapillary retinal nerve fiber layer (pRNFL).

Results: Seventy-four participants were enrolled and divided into two groups according to their Fazekas score (Fazekas scores ≤ 1 and ≥2). Participants with Fazekas score ≥2 showed significantly reduced RPC density (P = 0.02) and DCP density (P = 0.012) when compared with participants with Fazekas score ≤ 1. Participants with Fazekas score ≥2 showed reduced pRNFL (P = 0.004) when compared to participants with Fazekas score ≤ 1. Fazekas scores were significantly associated with the pRNFL thickness (Rho = −0.389, P = 0.001), RPC density (Rho = −0.248, P = 0.035), and DCP density (Rho = −0.283, P = 0.015), respectively.

Conclusions: Microvascular impairment and neuro-axonal damage are associated with the disease cascade in WMH. We have shown that RPC and DCP densities are significantly affected, and these impairments are associated with the severity of the disease and cognitive function. OCT-A could be a useful tool in quantifying the retinal capillary densities in WMH.

Evaluation of retinal vessel density and choriocapillaris flow in migraine patients with and without aura

PURPOSE

Migraine is thought to be a neurovascular disorder and increases the likelyhood to develop ischemic complications. Studies have shown that vascular disorders such as ischemic optic neuropathy, retinal artery and vein obstructions are more common in patients with migraine. This study aimed to evaluate the differences between retinal and optic disc microvasculature between migraine patients with and without aura and healthy controls using optical coherence tomography angiography (OCTA) imaging.

METHODS

Thirty-three patients with migraine and 28 healthy subjects were included in this prospective cross sectional study. Optical coherence tomography angiography imaging was performed for the macula and optic disc. Vessel densities (VD) and choriocapillaris flow values were compared between three groups: control group, migraine with aura (MWA), and migraine without aura (MWOA).

RESULTS

There was no difference between the three groups for the VDs of the foveal, perifoveal, parafoveal, and the whole area. The choriocapillaris flow of patients with MWA was significantly less than that of the MWOA and control groups. The VDs of the optic disc revealed no significant difference between the three groups.

CONCLUSION

A lack of choriocapillaris autoregulatory mechanisms may be a possible cause of the decrease in choriocapillaris flow in patients with MWA.

Are Retinal and Peripapillary Blood Flows Affected during Migraine Attack?

Migraine pathophysiology is complex and partially includes the vasculature. This study compared retinal and peripapillary blood flow parameters in migraine patients during an attack with healthy controls using optical coherence tomography angiography (OCTA). A prospective clinical study was conducted including 52 eyes from 26 migraineurs and 48 eyes from 24 healthy controls. OCTAs were performed with RTVue XR Avanti using AngioVue software. OCTA imaging was performed during the attack period in migraineurs before any treatment for the attack. Vascular densities in the whole image, fovea, superior hemisphere, inferior hemisphere, and temporal, superior, nasal, and inferior regions of the parafoveal area and in the superficial and deep capillary plexuses were acquired and statistically analysed. The flow density parameters were measured in the superficial retinal capillary plexus, deep retinal capillary plexus, outer retinal capillary plexus, and choriocapillaris layers of the macula in a 3-mm diameter area. The peripapillary flow densities were measured for the optic nerve head, vitreous, radial peripapillary capillaries, and choroid in a 4.50-mm diameter area around the optic disc. Vascular density measurements in the superficial plexus were similar between migraineurs and controls (p > .05). Vascular densities in the deep capillary plexus were similar between groups (p > .05), except in the deep superior area (p = .05). Flow areas in the nerve head, vitreous, peripapillary capillary, and choroid segments were similar between migraineurs and controls (p > .05). Macular thickness parameters were also similar between groups (p > .05). The results suggest that an acute migraine attack does not affect retinal or peripapillary blood flow.

Altered Macular Vasculature in Migraine Patients without Aura: Is It Associated with Ocular Vasculature and White Matter Hyperintensities?

Aim

We aimed to determine the alterations in macular and optic nerve vasculature in patients with migraine without aura using optical coherence tomography-angiography (OCTA). We also aimed to determine whether there were clinical differences and alterations in ocular structures in migraine cases with white matter hyperintensities (WMH) using magnetic resonance imaging (MRI). Materials and Methods. The study group comprised patients with migraine without aura and age- and sex-matched healthy controls. Detailed histories of the patients with migraine were recorded including the disease duration, number of attacks in the last month, and attack durations. Visual evoked potentials (VEP) were recorded in all migraine patients. The migraine disability assessment (MIDAS) questionnaire was administered to all patients. The patients were divided into two groups as migraine with WMHs and migraine without WMHs. All subjects underwent a complete neurological and ophthalmological examination. Only the right eyes of the patients were included in the study. Retinal imaging was performed using OCT and OCTA.

Results

A total of 66 migraine patients (29 with WMH and 37 without WMH) and 43 healthy controls were included in this study. Among the migraine patients, disease duration, attack frequency in the last month, attack durations, and the visual analogue scale (VAS), MIDAS, and VEP scores were all similar between those with and without WMHs. There was no significant difference between the groups regarding the ganglion cell complex, foveal, and retinal nerve fiber layer thicknesses. The superficial or deep vascular perfusion densities of the optic disc were also similar between the groups. The foveal avascular zone (FAZ) was significantly larger (P=0.034), and both superficial and deep macular vascular densities were significantly lower in the migraine groups compared with the healthy controls (P=0.001). There was no significant difference concerning the FAZ size or vascular densities between the migraine groups with and without WMHs. In the correlation analysis performed between the migraine patients, the FAZ size was correlated with age and VAS and MIDAS scores while both superficial and deep macular vascular densities were negatively correlated with age and VAS and MIDAS scores.

Conclusion

We suggest that for not only migraine with aura but also migraine without aura, neurovascular structures play an important role in pathogenesis, and novel studies are warranted to elucidate the alterations in these and determine the significance of WMHs in these patient groups.

Absence of peripapillary retinal nerve-fiber-layer thinning in combined antiretroviral therapy-treated, well-sustained aviremic persons living with HIV

Purpose

To compare peripapillary retinal nerve-fiber–layer (pRNFL) thickness, total retina macular volume, and ganglion-cell-layer (GCL) macular volume and thickness between persons living with HIV (PLHIVs) with well-controlled infections and good immune recovery, and sex- and age-matched HIV-uninfected controls (HUCs).

Methods

This prospective cross-sectional study (www.clinicaltrials.gov identifier: NCT02003989) included 56 PLHIVs, infected for ≥10 [median 20.2] years and with sustained plasma HIV-load suppression on combined antiretroviral therapy (cART) for ≥5 years, and 56 matched HUCs. Participants underwent spectral-domain optical coherence tomography (SD-OCT) with thorough ophthalmological examinations and brain magnetic resonance imaging (MRI). Their overall and quadrant pRNFL thicknesses, total macular volumes, and GCL macular volumes and thicknesses were compared. Cerebral small-vessel diseases (CSVD) complied with STRIVE criteria.

Results

Median [interquartile range, IQR] ages of PLHIVs and HUCs, respectively, were 52 [46–60] and 52 [44–60] years. Median [IQR] PLHIVs’ nadir CD4+ T-cell count and current CD4/CD8 T-cell ratio were 249/μL [158–350] and 0.95 [0.67–1.10], respectively; HIV-seropositivity duration was 20.2 [15.9–24.5] years; cART duration was 16.8 [12.6–18.6] years; and aviremia duration was 11.4 [7.8–13.6] years. No significant between-group pRNFL thickness, total macular volume, macular GCL-volume and -thickness differences were found. MRI-detected CSVD in 21 (38%) PLHIVs and 14 (25%) HUCs was associated with overall thinner pRNFLs, and smaller total retina and GCL macular volumes, independently of HIV status.

Conclusions

SD-OCT could not detect pRNFL thinning or macular GCL-volume reduction in well-sustained, aviremic, cART-treated PLHIVs who achieved good immune recovery. However, CSVD was associated with thinner pRNFLs and GCLs, independently of HIV status.

Vascular changes with optical coherence tomography angiography during aura of migraine: A case report

PURPOSE

To demonstrate macular and optic disk vessel changes by optical coherence tomography angiography during and after a migraine attack with aura.

METHODS

Case report.

RESULTS

A 34-year-old healthy female patient was evaluated by optical coherence tomography angiography imaging during visual aura with phosphenes in the left visual field. Optical coherence tomography angiography imaging showed diffuse narrowing of the retinal vessels, decreased radial peripapillary capillary density, and decreased superficial and deep foveal vessel density in the right eye. These changes improved 3 hours after visual aura. The patient suffered from right eye pain and right-sided headache, which are typical for migraine, after the visual aura.

CONCLUSION

These findings indicate that blood flow during migraine attack is reduced not only in the brain but also in the eye. Eye pain in migraine patients may be due to decreased blood flow in the eye. Restoring the vascular changes 3 hours after the visual aura suggests that vascular changes may be transient during a migraine attack.