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A comparative study of retinal layer changes among patients with schizophrenia and healthy controls

Published online by Cambridge University Press:  07 December 2022

Abhilaksh Kango
Affiliation:
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Sandeep Grover*
Affiliation:
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Vishali Gupta
Affiliation:
Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Swapnajeet Sahoo
Affiliation:
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Ritu Nehra
Affiliation:
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
*
Author for correspondence: Sandeep Grover, Email: drsandeepg2002@yahoo.com

Abstract

Aim:

This study aimed to evaluate the retinal nerve fibre layer changes among different group of patients with schizophrenia and compare it with healthy controls by using swept-source optical coherence tomography.

Methodology:

Patients with first-episode schizophrenia (n = 21) in remission (n = 35) or with treatment-resistant schizophrenia (TRS) (n = 35) and 36 healthy controls were evaluated for retinal thickness.

Results:

Patients with psychotic illnesses had significantly lower sub-foveal choroidal thickness (effect size 0.84–0.86), when compared to the healthy controls. When patients with first-episode schizophrenia were compared with patients with TRS, TRS patients had significant lower sub-foveal choroidal thickness (left eye) when the various confounders (such as age, gender, duration of treatment, smoking, current medications, body mass index, waist circumference, blood pressure, fasting glucose, HbA1c, presence or absence of metabolic syndrome) were taken into account. When the patients with TRS were compared with healthy controls, initially significant differences were observed for the macular volume (left and right) and the ganglion cell thickness (right eye) but these differences disappeared after controlling for the various covariates.

Conclusions:

Compared to healthy controls, patients with schizophrenia, psychotic illnesses have thinning of the retina, especially in the sub-foveal choroidal thickness.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology

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References

Alberti, KGMM, Eckel, RH, Grundy, SM, Zimmet, PZ, Cleeman, JI, Donato, KA, Fruchart, J-C, James, WPT, Loria, CM and Smith, SC (2009) Harmonizing the metabolic syndrome. Circulation 120(16), 16401645.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edn. Arlington, VA: American Psychiatric Association.Google Scholar
Andreasen, NC, Carpenter, WT, Kane, JM, Lasser, RA, Marder, SR and Weinberger, DR (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162(3), 441449. doi: 10.1176/appi.ajp.162.3.441.CrossRefGoogle ScholarPubMed
Ascaso, FJ, Laura, C, Quintanilla, MÁ., Gutiérrez Galve, L, López-Antón, R, Cristóbal, JA and Lobo, A (2010) Retinal nerve fiber layer thickness measured by optical coherence tomography in patients with schizophrenia: a short report. European Journal of Psychiatry 24(4), 227235.CrossRefGoogle Scholar
Ascaso, FJ, Rodriguez-Jimenez, R, Cabezón, L, López-Antón, R, Santabárbara, J, De la Cámara, C, Modrego, PJ, Quintanilla, MA, Bagney, A, Gutierrez, L, Cruz, N, Cristóbal, JA and Lobo, A (2015) Retinal nerve fiber layer and macular thickness in patients with schizophrenia: influence of recent illness episodes. Psychiatry Research 229(1-2), 230236. doi: 10.1016/j.psychres.2015.07.028.CrossRefGoogle ScholarPubMed
Bowd, C, Weinreb, RN, Williams, JM and Zangwill, LM (2000) The retinal nerve fiber layer thickness in ocular hypertensive, normal, and glaucomatous eyes with optical coherence tomography. Arch Ophthalmology 118(1), 2226.CrossRefGoogle ScholarPubMed
Brynskov, T, Laugesen, CS, Svenningsen, AL, Floyd, AK and Sørensen, TL (2016) Monitoring of diabetic retinopathy in relation to bariatric surgery: a prospective observational study. Obesity Surgery 26(6), 12791286. doi: 10.1007/s11695-015-1936-8.CrossRefGoogle ScholarPubMed
Cabezon, L, Ascaso, F, Ramiro, P, Quintanilla, M, Gutierrez, L, Lobo, A and Cristobal, J (2012) Optical coherence tomography: a window into the brain of schizophrenic patients. Acta Ophthalmologica 90() 90), 00. doi: 10.1111/j.1755-3768.2012.T123.x.Google Scholar
Celik, M, Kalenderoglu, A, Sevgi Karadag, A, Bekir Egilmez, O, Han-Almis, B and Şimşek, A (2016) Decreases in ganglion cell layer and inner plexiform layer volumes correlate better with disease severity in schizophrenia patients than retinal nerve fiber layer thickness: findings from spectral optic coherence tomography. European Psychiatry 32, 915. doi: 10.1016/j.eurpsy.2015.10.006.CrossRefGoogle ScholarPubMed
Chu, EM-Y, Kolappan, M, Barnes, TRE, Joyce, EM and Ron, MA (2012) A window into the brain: an in vivo study of the retina in schizophrenia using optical coherence tomography. Psychiatry Research: Neuroimaging 203(1), 8994. doi: 10.1016/j.pscychresns.2011.08.011.CrossRefGoogle Scholar
Dhasmana, R, Sah, S and Gupta, N (2016) Study of retinal nerve fibre layer thickness in patients with diabetes mellitus using fourier domain optical coherence tomography. Journal of Clinical and Diagnostic Research 10(7), NC05NC9. doi: 10.7860/JCDR/2016/19097.8107.Google ScholarPubMed
Gordon-Lipkin, E, Chodkowski, B, Reich, DS, Smith, SA, Pulicken, M, Balcer, LJ, Frohman, EM, Cutter, G and Calabresi, PA (2007) Retinal nerve fiber layer is associated with brain atrophy in multiple sclerosis. Neurology 69(16), 16031609. doi: 10.1212/01.wnl.0000295995.46586.ae.CrossRefGoogle ScholarPubMed
Heatherton, TF, Kozlowski, LT, Frecker, RC and Fagerström, KO (1991) The fagerström test for nicotine dependence: a revision of the fagerström tolerance questionnaire. British Journal of Addiction 86(9), 11191127. doi: 10.1111/j.1360-0443.1991.tb01879.x.CrossRefGoogle ScholarPubMed
Howes, OD, McCutcheon, R, Agid, O, de Bartolomeis, A, Citrome, L, Daskalakis, ZJ, Davidson, M, Drake, RJ, Dursun, S, Ebdrup, BH, Elkis, H, Falkai, P, Fleischacker, WW, Gadelha, A, Gaughran, F, Glenthøj, BY, Graff-Guerrero, A, Hallak, JEC, Honer, WG, Kennedy, J, Kinon, BJ, Lawrie, SM, Lee, J, Leweke, FM, MacCabe, JH, McNabb, CB, Meltzer, H, Möller, H-J, Nakajima, S, Pantelis, C, Reis Marques, T, Remington, G, Rossell, SL, Russell, BR, Siu, CO, Suzuki, T, Sommer, IE, Taylor, D, Thomas, N, Üçok, A, Umbricht, D, Walters, JTR, Kane, J and Correll, CU (2016) Treatment-resistant schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. American Journal of Psychiatry 174, 216229. doi: 10.1176/appi.ajp.2016.16050503.CrossRefGoogle Scholar
Jerotic, S, Ristic, I, Ignjatovic, Z and Maric, N (2020) T168. Macular thinning in female patients with psychosis spectrum disorders: preliminary optical coherence tomography findings. Schizophrenia Bulletin 46, S295. doi: 10.1093/schbul/sbaa029.728.CrossRefGoogle Scholar
Joe, P, Ahmad, M, Riley, G, Weissman, J, Smith, RT and Malaspina, D (2018) A pilot study assessing retinal pathology in psychosis using optical coherence tomography: choroidal and macular thickness. Psychiatry Research 263, 158161. doi: 10.1016/j.psychres.2018.03.011.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A and Opler, LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13(2), 261276. doi: 10.1093/schbul/13.2.261.CrossRefGoogle ScholarPubMed
Lai, A, Crosta, C, Loftin, M and Silverstein, SM (2020) Retinal structural alterations in chronic versus first episode schizophrenia spectrum disorders. Biomarkers in Neuropsychiatry 2, 100013. doi: 10.1016/j.bionps.2020.100013.CrossRefGoogle Scholar
Lee, WW, Tajunisah, I, Sharmilla, K, Peyman, M and Subrayan, V (2013) Retinal nerve fiber layer structure abnormalities in schizophrenia and its relationship to disease state: evidence from optical coherence tomography. Investigative Opthalmology & Visual Science 54(12), 77857792. doi: 10.1167/iovs.13-12534.CrossRefGoogle ScholarPubMed
Liao, C-H, Chang, C-S, Wei, W-C, Chang, S-N, Liao, C-C, Lane, H-Y and Sung, F-C (2011) Schizophrenia patients at higher risk of diabetes, hypertension and hyperlipidemia: a population-based study. Schizophrenia Research 126(1-3), 110116. doi: 10.1016/j.schres.2010.12.007.CrossRefGoogle ScholarPubMed
Lin, XG, Yi, ZQ, Zhang, XL, Liu, QQ, Cai, RY, Chen, CC, Zhang, HJ, Zhao, PW and Pan, PL (2020) Retinal nerve fiber layer changes in migraine: a protocol for systematic review and meta-analysis. Medicine (Baltimore) 99(33), e21680. doi: 10.1097/MD.0000000000021680.CrossRefGoogle Scholar
Manjunath, V, Taha, M, Fujimoto, JG and Duker, JS (2010) Choroidal thickness in normal eyes measured using Cirrus HD optical coherence tomography. American Journal of Ophthalmology 150(3), 325329.e1. doi: 10.1016/j.ajo.2010.04.018.CrossRefGoogle ScholarPubMed
Miller, M, Zemon, V, Nolan-Kenney, R, Balcer, LJ, Goff, DC, Worthington, M, Hasanaj, L and Butler, PD (2020) Optical coherence tomography of the retina in schizophrenia: Inter-device agreement and relations with perceptual function. Schizophrenia Research 219, 1318. doi: 10.1016/j.schres.2019.10.046.CrossRefGoogle ScholarPubMed
Nasrallah, HA, Meyer, JM, Goff, DC, McEvoy, JP, Davis, SM, Stroup, TS and Lieberman, JA (2006) Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research 86(1-3), 1522. doi: 10.1016/j.schres.2006.06.026.CrossRefGoogle ScholarPubMed
Pan, J, Zhou, Y, Xiang, Y and Yu, J (2018) Retinal nerve fiber layer thickness changes in schizophrenia: a meta-analysis of case-control studies. Psychiatry Research 270, 786791. doi: 10.1016/j.psychres.2018.10.075.CrossRefGoogle ScholarPubMed
Patel, MX, Arista, IA, Taylor, M and Barnes, TRE (2013) How to compare doses of different antipsychotics: a systematic review of methods. Schizophrenia Research 149(1-3), 141148. doi: 10.1016/j.schres.2013.06.030.CrossRefGoogle ScholarPubMed
Pulicken, M, Gordon-Lipkin, E, Balcer, LJ, Frohman, E, Cutter, G and Calabresi, PA (2007) Optical coherence tomography and disease subtype in multiple sclerosis. Neurology 69(22), 20852092. doi: 10.1212/01.wnl.0000294876.49861.dc.CrossRefGoogle ScholarPubMed
Samani, NN, Proudlock, FA, Siram, V, Suraweera, C, Hutchinson, C, Nelson, CP, Al-Uzri, M and Gottlob, I (2018) Retinal layer abnormalities as biomarkers of schizophrenia. Schizophrenia Bulletin 44(4), 876885. doi: 10.1093/schbul/sbx130.CrossRefGoogle ScholarPubMed
Schönfeldt-Lecuona, C, Kregel, T, Schmidt, A, Kassubek, J, Dreyhaupt, J, Freudenmann, RW, Connemann, BJ, Gahr, M and Pinkhardt, EH (2019) Retinal single-layer analysis with optical coherence tomography (OCT) in schizophrenia spectrum disorder. Schizophrenia Research 219, 512. doi: 10.1016/j.schres.2019.03.022.CrossRefGoogle ScholarPubMed
Schönfeldt-Lecuona, C, Kregel, T, Schmidt, A, Pinkhardt, EH, Lauda, F, Kassubek, J, Connemann, BJ, Freudenmann, RW and Gahr, M (2016) From imaging the brain to imaging the retina: optical coherence tomography (OCT) in schizophrenia. Schizophrenia Bulletin 42, 914. doi: 10.1093/schbul/sbv073.Google ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R and Dunbar, GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 2233.Google ScholarPubMed
Silverstein, SM, Fradkin, SI and Demmin, DL (2019) Schizophrenia and the retina: towards a 2020 perspective. Schizophrenia Research 219, 8494. doi: 10.1016/j.schres.2019.09.016.CrossRefGoogle ScholarPubMed
Silverstein, SM, Paterno, D, Cherneski, L and Green, S (2018) Optical coherence tomography indices of structural retinal pathology in schizophrenia. Psychological Medicine 48(12), 20232033. doi: 10.1017/S0033291717003555.CrossRefGoogle ScholarPubMed
Silverstein, SM and Rosen, R (2015) Schizophrenia and the eye. Schizophrenia Research: Cognition 2(2), 4655. doi: 10.1016/j.scog.2015.03.004.Google ScholarPubMed
Spaide, RF, Koizumi, H, Pozzoni, MC and Pozonni, MC (2008) Enhanced depth imaging spectral-domain optical coherence tomography. American Journal of Ophthalmology 146(4), 496500. doi: 10.1016/j.ajo.2008.05.032.CrossRefGoogle ScholarPubMed
Topcu-Yilmaz, P, Aydin, M and Ilhan, BC (2019) Evaluation of retinal nerve fiber layer, macular, and choroidal thickness in schizophrenia: spectral optic coherence tomography findings. Psychiatry and Clinical Psychopharmacology 29(1), 2833. doi: 10.1080/24750573.2018.1426693.CrossRefGoogle Scholar
Yılmaz, U, Küçük, E, Ülgen, A, Özköse, A, Demircan, S, Ulusoy, DM and Zararsız, G (2016) Retinal nerve fiber layer and macular thickness measurement in patients with schizophrenia. European Journal of Ophthalmology 26(4), 375378. doi: 10.5301/ejo.5000723.CrossRefGoogle ScholarPubMed
Zarogianni, E, Moorhead, TWJ and Lawrie, SM (2013) Towards the identification of imaging biomarkers in schizophrenia, using multivariate pattern classification at a single-subject level. NeuroImage: Clinical 3, 279289. doi: 10.1016/j.nicl.2013.09.003.CrossRefGoogle Scholar