Visual Function and Retinal Changes in Patients With Bipolar Disorder

García‐Martín, Elena; Gavin, Alicia; Campayo, Javier García; Viladés, Elisa; Orduna, Elvira; Polo, Vicente; Larrosa, José M.; Júlvez, Luis Pablo; Satué, María

doi:10.1097/iae.0000000000002252

Cited by 35 publications

(39 citation statements)

References 41 publications

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“…A few studies have examined RNFL thickness using OCT in SCZ and BD patients and have reported thinning of the RNFL and the inner nuclear layer in patients compared to HV.…”

Section: Discussionmentioning

confidence: 99%

Examination of retinal vascular trajectory in schizophrenia and bipolar disorder

Appaji

Nagendra

Chako

et al. 2019

Psychiatry Clin Neurosci

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Aim: Evidence suggests microvascular dysfunction (wider retinal venules and narrower arterioles) in schizophrenia (SCZ) and bipolar disorder (BD). The vascular development is synchronous with neuronal development in the retina and brain. The retinal vessel trajectory is related to retinal nerve fiber layer thinning and cerebrovascular abnormalities in SCZ and BD and has not yet been examined. Hence, in this study we examined the retinal vascular trajectory in SCZ and BD in comparison with healthy volunteers (HV).Methods: Retinal images were acquired from 100 HV, SCZ patients, and BD patients, respectively, with a non-mydriatic fundus camera. Images were quantified to obtain the retinal arterial and venous trajectories using a validated, semiautomated algorithm. Analysis of covariance and regression analyses were conducted to examine group differences. A supervised machine-learning ensemble of bagged-trees method was used for automated classification of trajectory values.Results: There was a significant difference among groups in both the retinal venous trajectory (HV: 0.17 AE 0.08; SCZ: 0.25 AE 0.17; BD: 0.27 AE 0.20; P < 0.001) and the arterial trajectory (HV: 0.34 AE 0.15; SCZ: 0.29 AE 0.10; BD: 0.29 AE 0.11; P = 0.003) even after adjusting for age and sex (P < 0.001). On post-hoc analysis, the SCZ and BD groups differed from the HV on retinal venous and arterial trajectories, but there was no difference between SCZ and BD patients. The machine learning showed an accuracy of 86% and 73% for classifying HV versus SCZ and BD, respectively.Conclusion: Smaller trajectories of retinal arteries indicate wider and flatter curves in SCZ and BD. Considering the relation between retinal/cerebral vasculatures and retinal nerve fiber layer thinness, the retinal vascular trajectory is a potential marker for SCZ and BD. As a relatively affordable investigation, retinal fundus photography should be further explored in SCZ and BD as a potential screening measure.

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“…A few studies have examined RNFL thickness using OCT in SCZ and BD patients and have reported thinning of the RNFL and the inner nuclear layer in patients compared to HV.…”

Section: Discussionmentioning

confidence: 99%

Examination of retinal vascular trajectory in schizophrenia and bipolar disorder

Appaji

Nagendra

Chako

et al. 2019

Psychiatry Clin Neurosci

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“…24 Celik et al 24 also showed that GCL-IPL volume was smaller in treatment-refractory patients compared to responsive patients. On the other hand, Garcia-Martin et al, 32 found a strong positive correlation between GCL thickness and disease duration, whereas Khalil et al 29 did not find any associations between GCC and clinical measures of disease severity or duration. No differences were observed for GCL volume between smokers and non-smokers.…”

Section: Gcl Gcl-ipl and Gcc Findingsmentioning

confidence: 93%

“…However, 5 studies reported a significant negative relationship between RNFL thickness and disease duration, 25,26,30,33,34 while 6 others did not observe a relationship. 23,24,27,29,31,32 Additionally, RNFL thinning was associated with worse clinical symptom severity in one study, 33 no association in 7 studies [24][25][26][27]29,32,34 and when stratified by recent illness episode vs non-recent illness episode or by treatment responsive vs refractory, there were no differences in RNFL thickness for the recent illness vs controls or between treatment response groups. 23,24 In order to explain these findings, Ascaso hypothesized that neuro-inflammation, which can occur during acute episodes, may increase RNFL thickness, thus masking thinning in RNFL that are seen in chronic SZ and BD patients.…”

Section: Rnfl Findingsmentioning

confidence: 94%

“…Twelve studies were eligible for quantitative analysis, which included 521 patients (SZ = 315 and BD = 206) and 496 HC (table 1). [23][24][25][26][27][28][29][30][31][32][33][34] Differences in Peripapillary RNFL Thickness Twelve studies were analyzed for overall peripapillary RNFL thickness with a total of 820 eyes from probands (541 SZ and 279 BD) and 904 eyes from HC (575 in SZ and 329 in BD studies). Compared to HC eyes, the overall peripapillary RNFL was thinner in probands Seven studies included the superior and inferior peripapillary RNFL thickness, and the sample consisted of 460 patient eyes (320 SZ and 140 BD) and 514 HC eyes (374 in SZ and 140 in BD studies).…”

Section: Studies Selectionmentioning

confidence: 99%

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A Meta-analysis of Retinal Cytoarchitectural Abnormalities in Schizophrenia and Bipolar Disorder

Lizano

Bannai

Lutz

et al. 2019

Schizophrenia Bulletin

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Background Schizophrenia (SZ) and bipolar disorder (BD) are characterized by reductions in gray matter and white matter. Limitations in brain imaging have led researchers to use optical coherence tomography (OCT) to explore retinal imaging biomarkers of brain pathology. We examine the retinal layers that may be associated with SZ or BD. Methods Articles identified using PubMed, Web of Science, Cochrane Database. Twelve studies met inclusion for acutely/chronically ill patients. We used fixed or random effects meta-analysis for probands (SZ and BD), SZ or BD eyes vs healthy control (HC) eyes. We adjusted for sources of bias, cross-validated results, and report standardized mean differences (SMD). Statistical analysis performed using meta package in R. Results Data from 820 proband eyes (SZ = 541, BD = 279) and 904 HC eyes were suitable for meta-analysis. The peripapillary retinal nerve fiber layer (RNFL) showed significant thinning in SZ and BD eyes compared to HC eyes (n = 12, SMD = −0.74, −0.51, −1.06, respectively). RNFL thinning was greatest in the nasal, temporal, and superior regions. The combined peripapillary ganglion cell layer and inner plexiform layer (GCL-IPL) showed significant thinning in SZ and BD eyes compared to HC eyes (n = 4, SMD = −0.39, −0.44, −0.28, respectively). No statistically significant differences were identified in other retinal or choroidal regions. Clinical variables were unrelated to the RNFL or GCL-IPL thickness by meta-regression. Conclusion The observed retinal layer thinning is consistent with the classic gray- and white-matter atrophy observed on neuroimaging in SZ and BD patients. OCT may be a useful biomarker tool in studying the neurobiology of psychosis.

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“…151 Therefore, the absence of more observations of total retinal thickness change in BD may be a result of masking of thinning by simultaneous thickening of other layers. 150 Newer, swept-source OCT able to image both the retina and choroid has been used to examine patients with BD, demonstrating significant thinning in the central macula, as well as in the inner temporal, nasal and inferior zones ( Table 2). 86 However, no changes in choroidal thickness were observed.…”

Section: Rnfl Changes In Bipolar Disordermentioning

confidence: 99%

Retinal correlates of psychiatric disorders

Almonte

Capellàn

Yap

et al. 2020

Therapeutic Advances in Chronic Disease

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Diagnosis and monitoring of psychiatric disorders rely heavily on subjective selfreports of clinical symptoms, which are complicated by the varying consistency of accounts reported by patients with an impaired mental state. Hence, more objective and quantifiable measures have been sought to provide clinicians with more robust methods to evaluate symptomology and track progression of disease in response to treatments. Owing to the shared origins of the retina and the brain, it has been suggested that changes in the retina may correlate with structural and functional changes in the brain. Vast improvements in retinal imaging, namely optical coherence tomography (OCT) and electrodiagnostic technology, have made it possible to investigate the eye at a microscopic level, allowing for the investigation of potential biomarkers in vivo. This review provides a summary of retinal biomarkers associated with schizophrenia, bipolar disorder and major depression, demonstrating how retinal biomarkers may be used to complement existing methods and provide structural markers of pathophysiological mechanisms that underpin brain dysfunction in psychiatric disorders.

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Visual Function and Retinal Changes in Patients With Bipolar Disorder

Abstract: Patients with bipolar disorder present quantifiable thinning of the macular RNFL, ganglion cell layer, and inner plexiform layer, as well as in the peripapillary RNFL thickness, and increasing thinning in the inner nuclear layer.

Cited by 35 publications

References 41 publications

Examination of retinal vascular trajectory in schizophrenia and bipolar disorder

Examination of retinal vascular trajectory in schizophrenia and bipolar disorder

A Meta-analysis of Retinal Cytoarchitectural Abnormalities in Schizophrenia and Bipolar Disorder

Retinal correlates of psychiatric disorders

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