Optical Coherence Tomography Angiography (OCTA) demonstrates enlarged foveal avascular zone and deceased macular vessel density in patients with migraine with aura

Abstract

Purpose : Migraine is one of the most common disorders worldwide, with an estimated prevalence of 13% (5% with aura). Migraineurs with aura have an increased risk of cerebral and retinal vascular ischemic events. We studied the retinal vasculature in patients with a history of migraine using optical coherence tomography angiography (OCTA).

Methods : Adults with migraines with aura (MA) or without aura (MO), as well as controls without migraines based on ICHD3 criteria were recruited from ophthalmology and neurology clinics. Subjects with retinal or optic nerve pathology or known microvascular disease were excluded. All subjects underwent 3.0x3.0mm macular angiography scans using the RTVue XR 100 Avanti OCTA device (Optovue, Fremont, CA). Macular vessel density (MVD) in the superficial (SCP) and deep retinal capillary plexus (DCP) and foveal avascular zone (FAZ) area were measured. Foveal thickness was also measured using the same device. Statistical analysis was performed with the Mann-Whitney test. P-values less than 0.05 were considered significant.

Results : We recruited eight MA subjects, six MO, and 19 age-matched controls. The mean age was 44±11 years and did not differ among groups (p=0.55). The MVD of the SCP in the MA group was significantly lower than controls (30.6±2.6% vs. 32.7±3.3%, p=0.01) and the superficial FAZ was significantly larger in MA subjects compared to controls (0.28±0.07mm² vs. 0.23±0.07mm², p=0.03). The deep MVD and FAZ did not differ between MA subjects and controls (p>0.22). There were no differences between the MO group and controls in superficial or deep MVD or FAZ (p>0.21). There was no difference in foveal thickness between controls and either migraine group (p>0.51).

Conclusions : Migraine with aura, but not without aura, is associated with an enlarged FAZ and decreased MVD at the SCP level. Further studies are necessary to determine if retinal vascular abnormalities correlate with cerebrovascular changes and risk of ischemic complications in migraineurs. OCTA may potentially be useful as a biomarker in patients with migraine with aura.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.