Authors: Megan Kasetty1,3 BS, Paulo Lizano2 MD, PhD, Rebecca Zeng1 BS, Jay Wang1 MD, Jose Daniel Diaz1 MD, Matcheri Keshavan2 MD, John Miller1 MD

  1. Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Boston MA
  2. Beth Israel Deaconess Medical Center, Department of Psychiatry, Boston, MA
  3. Tufts University School of Medicine, Boston, MA

Purpose: An emerging area of research in psychiatric and neurodegenerative disorders is retinal imaging. The retina can be imaged quickly and noninvasively to provide a window into the central nervous system. We use optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to measure chorioretinal thicknesses and retinal vessel density in patients with schizophrenia, schizoaffective disorder or psychotic bipolar I disorder.

Methods:38 eyes of 19 patients with psychotic symptoms and 16 eyes of 8 healthy individuals were imaged using Spectral Domain OCT (SD-OCT) and Swept Source OCTA (SS-OCT). SD-OCT images were segmented to calculate thickness measurements of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and full retina in each of the nine Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid areas. Macular SS-OCTA images were extracted from the superficial and deep vascular plexuses and the choriocapillaris. Automated thresholding techniques were used to create a binarized image, from which vessel area density (VAD) was calculated and a skeletonized image, from which vessel skeletonized density (VSD) was calculated. Choroidal thickness was measured in each of the nine macular areas. Linear mixed model analysis was performed.

Results: Overall retinal thickness and RNFL thickness were found to be thinner in psychosis patients versus controls, though this difference did not reach statistical significance. There was a significant reduction in RNFL thickness in the inner temporal region (16.7 versus 17.9 μm; p = 0.023).  Average choroidal thickness was slightly thicker in psychosis patients, though non-significantly. Parafoveal superficial VAD and VSD were lower in cases versus control, while deep and choriocapillaris VSD was slightly greater. A sub-analysis was performed based on the duration of psychotic symptoms. Eyes from subjects with symptoms lasting fewer than five years trended towards thinner average retinal and choroidal thicknesses, and greater VAD and VSD in all layers when compared to eyes from subjects with five or more years of symptoms, but none of these comparisons reached statistical significance.

Conclusions:Macular thinning in psychosis patients may be indicative of inflammatory or degenerative processes. Further studies with greater statistical power are needed to investigate correlations between clinical and structural findings, particularly involving the retinal and choroidal vasculature.

Financial Disclosures: No relevant financial disclosures for any contributing authors