The effect of cigarette smoking on retinal nerve fiber layer thickness in patients with migraine

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.

Secondhand smoke exposure and ocular health: A systematic review

The toxicology of secondhand smoke (SHS), along with the harm of its exposure to human health, has been generally acknowledged; however, specific evidence is lacking on the association between SHS exposure and ocular health. In this systematic review (PROSPERO registration number: CRD42022247992), we included 55 original articles published by 12 May 2023, which dealt with SHS exposure and ocular disorders, such as eye irritation, conjunctivitis, dry eye diseases, uveitis, myopia, astigmatism, contact lens discomfort, age-related macular degeneration, glaucoma, and thyroid eye disease that addressed the ocular neurovascular structures of the macular, retinal nerve fiber layer, choroid, and corneal biomechanical parameters. We found compelling correlational evidence for eye irritation, conjunctivitis, and dry eye symptoms-supporting that SHS exposure was positively associated with inflammatory and allergic changes in the eyes. Yet, evidence about the associations between SHS exposure and other ocular disorders, structures, and parameters is still limited or controversial. Given the limitations of existing literature, more investigations with high quality and rigorous design are warranted to elucidate the potentially harmful effects of SHS exposure on ocular health.

Positive correlation between hypertensive retinopathy and albuminuria in hypertensive adults

PURPOSE

We investigated the association between albuminuria and hypertensive retinopathy (HR) in hypertensive adults.

METHODS

This was a cross-sectional subgroup analysis of data from the China Stroke Primary Prevention Trial. We enrolled 2,964 hypertensive adults in this study. Keith-Wagener-Barker stages was used to assess HR. The urinary albumin to creatinine ratio (UACR) was calculated to evaluate albuminuria.

RESULTS

HR was found in 76.6% (n = 2, 271) of the participants, albuminuria was found in 11.1% (n = 330). The UACR levels were significantly higher in subjects with HR than in those without HR (grade 1, β = 1.42, 95% confidence intervals [CI]: -0.12, 2.95, p = 0.070; grade 2, β = 2.62, 95% CI: 0.56, 4.67, p = 0.013; grade 3, β = 5.17, 95% CI: 1.13, 9.20, p = 0.012). In the subgroup analyses, the association between HR and UACR was stronger in current smokers (p for interaction = 0.014). The correlation between HR grades 1 and 2 and UACR was stronger in subjects with higher triglyceride levels (≥ 1.7 mmol/L), but for grade 3 HR, this correlation was stronger in subjects with lower triglycerides levels (< 1.7 mmol/L, p for interaction = 0.023). The odds of albuminuria were significantly higher in subjects with HR than in those without HR (grade 1, odds ratio [OR] = 1.57, 95% CI: 1.08, 2.29, p = 0.019; grade 2, OR = 2.02, 95% CI: 1.28, 3.18, p = 0.002; grade 3, OR = 2.12, 95% CI: 0.99, 4.55, p = 0.053). In the subgroup analyses, the association between HR grades 1 and 2 and albuminuria was stronger in subjects with higher triglycerides levels (≥ 1.7 mmol/L), but for grade 3 HR, this correlation was stronger in subjects with lower triglyceride levels (< 1.7 mmol/L, p for interaction = 0.014).

CONCLUSION

HR was positively correlated with albuminuria in hypertensive Chinese adults. This correlation was more remarkable when the population was stratified by triglycerides levels and smoking status. HR can be used as an indicator of early renal injury.

Impact of Smoking on Visual Field Progression in a Long-term Clinical Follow-up

PURPOSE

To investigate the effect of smoking on rates of progressive visual field (VF) damage over time in glaucoma.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Five hundred eleven eyes of 354 patients with glaucoma followed up from multicenter glaucoma registries.

METHODS

In this longitudinal study, 354 patients with primary open-angle glaucoma with a minimum of 3 years of follow-up and 5 VF tests were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Univariate and multivariate linear mixed models were used to investigate the effects of smoking on rates of 24-2 VF mean deviation loss. Visual field progression was defined using pointwise linear and significant negative VF mean deviation loss. Logistic regression was used to identify baseline factors and whether different levels of smoking intensity were associated with VF progression. Kaplan-Meier survival analysis and the log-rank test were used to compare the cumulative risk ratio of progression between smoker and never smoker groups.

MAIN OUTCOME MEASURES

Visual field progression.

RESULTS

Five hundred eleven eyes of 354 patients were included over the median follow-up of 12.5 years. Median baseline age was 64.8 years. Of the 354 patients, 124 (35%) were Black, and 149 (42.1%) and 168 (59.8%) had reported a history of smoking or alcohol consumption, respectively. In a multivariate model, higher smoking intensity was associated with faster VF loss (coefficient, -0.05 decibels (dB)/year per 10 pack-years; 95% confidence interval [CI], -0.08 to -0.01 dB/year per 10 pack-years; P = 0.010). Developing VF progression in eyes of heavy smokers (≥ 20 pack-years) was 2.2 times more than in eyes of patients without smoking history (odds ratio, 2.21; 95% CI, 1.02-4.76; P = 0.044). Statistically significant differences were found between heavy smokers (≥ 20 pack-years) and never smokers by Kaplan-Meier analysis (P = 0.011, log-rank test).

CONCLUSIONS

Heavy smokers are more likely to sustain VF loss in eyes with glaucoma. The prospective longitudinal design of this study supports the hypothesis that levels of smoking may be a significant predictor for glaucoma progression. Additionally, this information can be used for clinically relevant tobacco prevention and intervention messages.

Smoking Cessation May Reduce Risk of Visual Field Progression in Heavy Smokers

PRCIS

The earlier a person quits smoking the more likely is the optic nerve be spared from damage.

PURPOSE

To investigate the effect of smoking cessation on visual field (VF) progression in glaucoma.

METHODS

Primary open angle glaucoma patients with a minimum of 3 years follow-up and 5 VFs were included. Linear mixed models were used to investigate the effects of smoking on the rates of 24-2 VF mean deviation loss after adjusting for confounding factors. Cox proportional hazard regression was used to identify whether different levels of smoking intensity were associated with VF progression with respect to different duration of quitting.

RESULTS

Five hundred eleven eyes of 354 patients were included over the mean follow-up of 12.4 years. Mean baseline age (95% confidence interval) was 62.3 (61.2, 63.4) years. One hundred forty nine (42.1%) patients were smokers. In a multivariable model, smoking intensity was associated with faster VF loss (-0.06, 95% confidence interval (-0.10, -0.01) dB/year per 10 pack-years, P =0.01) among smokers. Heavy smokers (≥20 pack-years) who had quit ˂25 years prior had significantly greater odds of VF progression compared with never smokers (odds ratio=2.49 (1.01, 6.08); P =0.046). There was no significant difference in odds of VF progression in heavy smokers who had quit smoking more than 25 years compared with never smokers ( P =0.43). A significantly higher proportion of VF progression was found in heavy smokers who quit < 25 years compared with heavy smokers who quit ≥25 years by Kaplan-Meier analysis ( P =<0.001).

CONCLUSIONS

After ≥25 years of smoking cessation, the risk of VF progression in former heavy smokers becomes similar to never smokers. Long-term smoking cessation may be associated with lower VF progression in glaucoma patients.

The Effect of Smoking on the Postoperative Course After Head and Neck Reconstruction With a Vascularized Free Flap: A Retrospective Study

OBJECTIVES

The objective of the present study is to determine the impact of smoking on hospital and intensive care unit stay, need for surgical reintervention, Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity, and surgical complications after head and neck reconstructions.

METHODS

All 153 patients who underwent head and neck reconstructions with free tissue transfer at the department of oral and maxillofacial surgery at the University Hospitals of Leuven between January 1, 2015 and December 31, 2018 were enrolled in this retrospective cohort study. Data from medical charts were extracted. Univariate and multiple regression analyses were performed. A level of significance of P < 0.05 (α = 0.05) was used.

RESULTS

Smoking was not associated with Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity, hospital or ICU stay, the incidence of postoperative complications in both flap and donor site, or surgical reintervention.

CONCLUSIONS

Regarding the outcomes included in this study, smoking status should not be considered as a critical factor in patient selection for head and neck reconstructions with a vascularized free flap.

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.

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.

Functional and Structural Changes of the Retinal Nerve Fiber Layer and Ganglion Cell Complex in Heavy Smokers

Purpose

To assess the functional and structural changes in the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) in heavy smokers using pattern electroretinogram (PERG), photopic negative response(PhNR) and spectral domain optical coherence tomography (SD-OCT).

Patients and Methods

Sixty eyes of 30 heavy smokers (at least 15 cigarettes/day for 10 years) (study group) and 60 eyes of 30 age and gender-matched healthy non-smoker subjects (control group) were included. After full ophthalmologic examination (PERG), (PhNR) using RETI-port/scan 21 (Roland Consult, Brandenburg, Germany) and (SD-OCT using Topcon 3D OCT model 2000 FA version.8.30) were tested for all participants. Statistical analysis was performed to compare GCC, RNFL thicknesses, PERG and phNR values between groups.

Results

The mean age was 36.67±4.13 years in the study group and 36.0±4.76 years in the control group. There were no statistical significant differences between the two groups regarding intraocular pressure (p=0.43), axial length (p=0.37), and central corneal thickness (p=0.86). There were significant differences of GCC thickness values between the study group (88.4±6.6 µm) and control group (94.83±5.25 µm) (p<0.001). The mean RNFL values of study and control groups were 97.87±5.88 and 106.43±6.59 µm, respectively (p<0.001). In the study group the superior and inferior quadrants of RNFL were significantly thinner, but there were no significant differences between the two groups in nasal and temporal quadrants. There were no significant differences of PERG-P50 amplitude (p=0.49) and latency (p=0.71); however, PERG-N95 amplitude and latency showed significant differences between the two groups (p<0.001).There were significant differences of phNR amplitude and latency between the two groups (p<0.001). Multiple regression analyses demonstrated that the PhNR, PERG amplitude and latency are the most important determinants for both RNFL and GCC thicknesses.

Conclusion

In heavy smokers RNFL thickness was decreased, the PhNR, PERG-N95 amplitudes were diminished and the implicit times were prolonged compared to non-smokers. PhNR and PERG reflect both dysfunction and loss of ganglion cells and their axons.

The effect of the smoking on choroidal thickness, central macular vascular and optic disc perfusion

OBJECTIVES

To compare choroidal thickness, central macular vascular perfusion and optic disc perfusion in smokers and non-smokers.

METHODS

Smoker participants defined group I and non-smoker participants(group II) Optical coherence tomography angiography (OCTA) performed to all volunteers and choroidal thickness, central macular vascular and optic disc perfusion were measured.

RESULTS

In group I, 30 eyes of the 30 participants (6 male and 24 female) evaluated and in group II, 32 eyes of the 32 participants (13 male and 19 female) evaluated. The mean age of the volunteers were 43.09 ± 14.28 and 42.2 ± 8.24 year-old in group I and group II, respectively. The mean choroidal thickness were 345 ± 74 μm and 301.6 ± 71 μm in group I and group II, respectively (p = 0.022). The mean optic disc perfusions were 45.17 ± 1.46% and 45.25 ± 1.43% in group I and group II, respectively (p = 0.82). The mean central macular vascular perfusions were 20.20 ± 7.17% and 18.65 ± 7.46% in group I and group II, respectively (p = 0.4). There are a negative correlation between macular vascular perfusion, optic disc perfusion and smoking period (p = 0.32 and 0.62, respectively.) CONCLUSION: Our study revealed that smoking statistically significantly effected choroidal thickness but effected central macular vascular and optic disc perfusion changes were not statistically significant.

Evaluation of the lamina cribrosa thickness and depth in patients with migraine

PURPOSE

The aim of the study was to evaluate the lamina cribrosa (LC) thickness, LC depth, and retinal nerve fiber layer (RNFL) thickness, in migraine patients with and without aura, by using optical coherence tomography (OCT).

METHODS

This single-center, case-control study included 27 migraine with aura (Group I), 35 migraine patients without aura (Group II), and 35 healthy controls (Group III). In only the right eyes of participants, RNFL thickness in all quadrants was analyzed via OCT, whereas LC thickness and depth were measured by enhanced depth imaging OCT.

RESULTS

The mean age and sex distributions did not differ significantly across the groups (p = 0.460 and p = 0.941). The RNFL thickness was significantly lower in Group I (average and superotemporal, superonasal, and inferotemporal quadrants) and Group II (average and superotemporal and superonasal quadrants) when compared with Group III. Disease duration was significantly correlated with RNFL thickness on average and in all quadrants except in the superonasal quadrant in Groups I and II. Patients in Groups I and II had significantly thinner LC thicknesses and deeper LC depth than healthy participants in Group III.

CONCLUSIONS

The LC and RNFL thicknesses were thinner and the LC depth was deeper in migraine patients with or without aura than in healthy individuals, and disease duration correlated significantly with RNFL thickness. Both results suggest that migraine patients are at risk of developing glaucoma.

The alteration of retinal nerve fibre layer thickness with repetitive transcranial magnetic stimulation in patients with treatment resistant major depression

OBJECTIVE

The nerves and axons of the retinal nerve fibre layer (RNFL) are similar to those in the brain and therefore retina is considered as the extension of the brain. We aimed to evaluate the RNFL thickness in the treatment-resistant major depressive patients before and after repetitive transcranial magnetic stimulation (rTMS) treatment and at least 6 months later after rTMS treatment using optical coherence tomography (OCT).

METHODS

Thirty patients with treatment resistant major depression and 24 healthy controls were included in the study. rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) of the patients.

RESULTS

rTMS was initiated in 28 patients. OCT assessments were performed in 24 patients at baseline and after rTMS treatment and in 19 patients at least sixth months after the rTMS treatment. We found significant increase in RNFL thickness compared with controls at the baseline and further increase in RNFL thickness after rTMS treatment. Although there was a decreasing trend in RNFL thickness 6 months after rTMS treatment, 6 months later RNFL thickness was still higher compared with controls.

CONCLUSIONS

RNFL thickness is increased in treatment resistant major depression and rTMS over the left DLPFC further increases RNFL thickness in treatment resistant major depressive patients.

The Effect of Smoking on Macular, Choroidal, and Retina Nerve Fiber Layer Thickness

Objectives

This study aimed to compare the thickness of the macula, choroid, and peripapillary retina nerve fiber layer (RNFL) in smokers with those of healthy, nonsmoking individuals using spectral domain optical coherence tomography (SD-OCT).

Materials and Methods

Sixty-eight healthy smokers with an average of 19.75 pack-years and 71 nonsmoker subjects (control group) were included in the study. Macular thickness, RNFL thickness, and choroidal thickness (CT) were measured by SD-OCT.

Results

The mean age of the smokers was 42.76±6.97 years and that of the control group was 41.15±11.61 years (p=0.32). Inferonasal and temporal RNFL thicknesses were 121.60±27.40 μm and 69.75±9.82 μm in the smokers group and 109.05±21.71 μm and 75.95±15.01 μm in the nonsmoker group, respectively. The differences were statistically significant (p=0.003, p=0.005, respectively). Central macular thickness (CMT) was 222.97±18.95 μm and subfoveal CT was 369.52±105.36 μm in the smoker group, while these values were 222.98±17.72 μm and 347.42±104.63 μm in the nonsmoker group, respectively. There were no significant differences in these comparisons (p=0.99, p=0.49, respectively). A significant negative correlation was found between smoking exposure and nasal and temporal CT.

Conclusion

The results of our study revealed that RNFL thickness was decreased but CMT and CT were not affected in healthy chronic smokers.

Cross-sectional study of smoking exposure: no differential effect on OCT metrics in a cohort of MS patients

Background

Optical coherence tomography (OCT) provides quantitative measures of retinal layer thickness. Cigarette smoking is a risk factor for multiple sclerosis (MS) onset and disease severity: its effects on OCT metrics have not been assessed.

Objective

The objective of this study was to assess the effect of smoking history on retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform (GCIP) of MS patients by OCT.

Methods

112 MS patients were recruited from the Brigham and Women’s Hospital. Spectralis OCT scans were acquired to measure GCIP, peripapillary RNFL, and total macular volume. Multivariable linear mixed effects regression model assessed RNFL and GCIP change with fixed effects for smoking history while adjusting for optic neuritis eye status, age, disease duration, sex, baseline EDSS, and disease modifying therapies (DMTs).

Results

Smoking histories were available for 102 patients: 46 (45.10%) had a history of smoking cigarettes and 56 (54.90%) never smoked. No statistically significant differences were found between ever-smokers and never-smokers with respect to GCIP, RNFL, and macular volume.

Conclusion

Our study shows no significant difference in retinal thickness between ever-smokers and never-smokers. If confirmed, this result suggests mechanistic differences between the retina and other central nervous system (CNS) compartments in response to smoking and should be noted when considering OCT as a surrogate measure of CNS activity.

The Impact of Chronic Tobacco Smoking on Retinal and Choroidal Thickness in Greek Population

Aim. To investigate the effect of more than 25-year cigarette smoking on choroidal and retinal thickness, using spectral domain optical coherence tomography (SD-OCT). Methods. Thirty-one smokers and 25 age- and sex-matched nonsmokers, serving as control group, were submitted to slit-lamp biomicroscopy and dilated fundoscopy, SD-OCT, measurements of intraocular pressure (IOP), central corneal thickness (CCT), and axial length (AL). Heidelberg Spectralis was used to calculate choroidal thickness (CT), ganglion cell complex (GCC), outer retina layers (ORL), and macular thicknesses (MT). Results. The smokers' group consisted of 17 males and 14 females with mean age of 57.8 ± 4.5 years, while the controls' group consisted of 14 males and 11 females with mean age of 68.0 ± 4.1 years. CT and GCC thicknesses were significantly reduced in smokers compared to control group. The differences in thicknesses of ORL were marginally significant between two groups. The measurements of MT, IOP, CCT, and AL had the same distributions between smokers and nonsmokers. Conclusions. Tobacco smoking seems to result in thinner choroid and retina compared to nonsmokers. This is the first study in literature that investigates the anatomical effect of smoking for more than 25 years on the choroid and retina.