Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Sep 20, 2025; 15(3): 100950
Published online Sep 20, 2025. doi: 10.5662/wjm.v15.i3.100950
Evaluation of macular and peripapillary structure and microvasculature with optical coherence tomography angiography in migraine in the Indian population
Pankti Shah, Virna M Shah, Veerappan Rathinasabapathy Saravanan, Karthik Kumar, Siddharth Narendran
Pankti Shah, Virna M Shah, Karthik Kumar, Department of Neuro Ophtalmology, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
Veerappan Rathinasabapathy Saravanan, Department of Vitreoretina, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
Siddharth Narendran, Division of Microbiology, Department of Cataract Services, Aravind Medical Research Foundation Regional Centre, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
Author contributions: Shah P and Kumar K conducted the study; Shah P and Narendran S analyzed the data and wrote the paper; Shah VM supervised the study; Shah VM and Saravanan VR designed the study; All authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Aravind Eye Hospital, Madurai, India.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to use of anonymous patient data for research at the time of registration in the outpatient department. We applied the opt-out method to obtain consent for this study by using a poster. The poster was approved by the Institutional Review Board.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at virna@aravind.org.
STROBE statement: The authors have read the STROBE Statement-checklist of items-and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Virna M Shah, DO, Chief Physician, Department of Neuro Ophthalmology, Aravind Eye Hospital, Tamilnadu, Coimbatore 641014, Tamil Nādu, India. virna@aravind.org
Received: September 2, 2024
Revised: November 21, 2024
Accepted: December 9, 2024
Published online: September 20, 2025
Processing time: 186 Days and 21.9 Hours
Abstract
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.

Keywords: Migraine; Aura; Optical coherence tomography angiography; Foveal microvasculature; Macular perfusion

Core Tip: Our observational study shows that there are microvascular and structural changes seen on optical coherence tomography angiography in migraine, and these changes could serve as a valuable non-invasive biomarker in its diagnosis.