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Microvascular changes in the macular area in patients with obstructive sleep apnoea syndrome compared to controls: A systematic review and meta-analysis

Eye volume 40, pages 170–176 (2026) Cite this article

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Abstract

To investigate retinal microvascular changes in patients with obstructive sleep apnoea syndrome (OSAS) compared to healthy controls. PUBMED and Scopus were searched for published studies comparing retinal microvascular indices on optical coherence tomography angiography (OCTA), between patients with OSAS and controls. Mean Differences (MD) with 95% confidence interval (CI) were computed for the comparisons. Revman 5.3 was used for the analysis. Our study was registered with PROSPERO with registration ID: CRD42024523329. 8 studies were included in our analysis. Foveal avascular zone (FAZ) area was enlarged in patients with OSAS compared to controls (MD = 0.04; 95% CI: 0.02, 0.07, p = 0.0004, I2 = 71%). The superficial capillary plexus vessel density was found to be decreased in patients with OSAS compared to controls in the foveal (MD = -1.54; 95% CI: -2.49, -0.58, P = 0.002, I2 = 0%), parafoveal (MD = -1.01; 95% CI: -1.48, -0.54, p < 0.0001, I2 = 0%) and whole image (MD = -1.40; 95% CI: -2.04, -0.76, p < 0.0001, I2 = 85%). The deep capillary plexus vessel density was found to be decreased in the foveal (MD = -2.32; 95% CI: -3.57, -1.06, p = 0.0003, I2 = 0%) parafoveal (MD = -2.05; 95% CI: -3.71, -0.39, p = 0.02, I2 = 91%) and whole image (MD = -1.37; 95% CI: -2.58, -0.16, p = 0.03, I2 = 88%). Subgroup analysis confirmed this finding in patients with mild, moderate and severe OSAS. Patients with OSAS exhibit an enlarged FAZ area and decreased vessel density in both the superficial and deep capillary plexus compared to control patients. These findings suggest that chronic intermittent hypoxia in patients with OSAS might adversely affect the retinal microvasculature. Prompt measures to prevent or treat OSAS are recommended.

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Fig. 1
The alternative text for this image may have been generated using AI.
Fig. 2: Forrest plot illustrating the mean difference in foveal avascular zone (FAZ) area between patients with obstructive sleep apnea syndrome (OSAS) and healthy controls as assessed by optical coherence tomography angiography (OCTA).
The alternative text for this image may have been generated using AI.
Fig. 3: Forrest plot showing the mean difference in superficial capillary plexus (SCP) vessel density between patients with obstructive sleep apnea syndrome (OSAS) and controls as measured by optical coherence tomography angiography (OCTA).
The alternative text for this image may have been generated using AI.
Fig. 4: Forrest plot demonstrating the mean difference in deep capillary plexus (DCP) vessel density between patients with OSAS and matched controls.
The alternative text for this image may have been generated using AI.

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Authors and Affiliations

  1. NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK

    Dimitrios Kazantzis, Francesca Lamanna, Ayse Merve Keskin & Sobha Sivaprasad

  2. Institute of Ophthalmology, University College London, London, UK

    Sobha Sivaprasad

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  1. Dimitrios Kazantzis
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  2. Francesca Lamanna
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Contributions

All authors report that they meet the current ICMJE criteria for Authorship. DK and AMK were responsible for conducting the literature search, extracting and analysing data and drafting the manuscript. FL and SS interpreted the results and critically revised the manuscript. All authors read and agreed with the submission of the final version of the manuscript.

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Correspondence to Dimitrios Kazantzis.

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Conflict of interest

Dr Sivaprasad reported receiving financial support from AbbVie, Amgen, Apellis, Bayer, Biogen, Boehringer Ingelheim, Novartis, Eyebiotech, Eyepoint Pharmaceuticals, Janssen Pharmaceuticals, Nova Nordisk, Optos, Ocular Therapeutics, Kriya Therapeutics, OcuTerra, Roche, Stealth Biotherapeutics, Sanofi and is a member of the Eye Editorial Board. All other authors declare no conflict of interest.

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Kazantzis, D., Lamanna, F., Keskin, A.M. et al. Microvascular changes in the macular area in patients with obstructive sleep apnoea syndrome compared to controls: A systematic review and meta-analysis. Eye 40, 170–176 (2026). https://doi.org/10.1038/s41433-025-04104-6

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