Caffeinated Analgesics May Increase Paracentral Acute Middle Maculopathy Risk

Caffeinated analgesics, which are ingested for migraine with aura treatment, may cause vasoconstriction and increase paracentral acute middle maculopathy risk, according to a poster presented at the American Optometric Association 2023 ePosters Virtual Event from June 13-14, 2023 in Washington, DC. 

Eryn Martinez, OD, presented a case report of a man (age, 41 years), who presented with a central blind spot in the right eye preceding a migraine. Using caffeinated analgesics allowed the migraine to subside, but the blind spot persisted, according to the report. Fundus examinations revealed inferior macular ischemia, optical coherence tomography-angiography (OCT-A) showed a hyperreflective band through the inner nuclear layer/ outer plexiform layer, and 10-2 horizontal visual fields revealed a mild superior paracentral scotoma in the right eye — all findings that are consistent with paracentral acute middle maculopathy. Uncorrected visual acuity was 20/25 and 20/20 in the right and left eyes, respectively. 

OCT-A revealed a less prominent hyperreflective band through the inner nuclear layer/ outer plexiform layer at 1-month follow up, but the scotoma remained unchanged, according to the report. 

The poster presenters state that paracentral acute middle maculopathy is often  associated with microvascular disease or retinal vascular conditions, and highlight the fact that the patient in their case study experienced neither condition. The use of caffeinated analgesics, however, may increase this risk. 

“In young, healthy patients with no known systemic or vascular conditions, it is important to consider other potential causes and environmental risk factors of retinal ischemia,” according to the poster presenters. “Migraines with aura and the treatment with caffeinated analgesics potentiate retinal vasoconstriction, thereby increasing the risk for [paracentral acute middle maculopathy].”