Division of Psychiatry, University College London, London, UK.
Department of Public Health Sciences, Unit of Public Health Epidemiology, Karolinska Institute, Stockholm, Sweden.
Schizophr Bull. 2019 Apr 25;45(3):571-578. doi: 10.1093/schbul/sby084.
We aimed to determine whether late adolescent visual impairment is associated with later psychosis.
We conducted a longitudinal cohort study of Swedish male military conscripts aged 18 or 19 years from January 1, 1974, through December 31, 1997 (N = 1140710). At conscription, uncorrected and optometry-lens-corrected distance visual acuity was measured. Participants were then followed up to see if they received an inpatient diagnosis of non-affective psychotic disorder, including schizophrenia (N = 10769). Multivariable Cox modeling was used to estimate differences between groups.
After adjustment for confounders, those with severe impairment before optical correction in their best eye (decimal fraction <0.3) had an increased psychosis rate compared to those with normal uncorrected vision (decimal fraction 1.0) (hazard ratio [HR] 1.26, 95% CI 1.16-1.37). Larger interocular visual acuity difference was associated with an increased psychosis rate (adjusted HR 1.49, 95% CI 1.37-1.63 in those with differences >0.5 compared to those with no between eye acuity difference). Individuals with impaired vision that could not be corrected to normal with lenses had highest rates of psychosis (best eye adjusted HR 1.56; 95% CI 1.33-1.82), those with imperfect, but correctable vision also had elevated rates (best eye adjusted HR 1.21; 95% CI 1.15-1.28). Individuals with visual impairment had higher rates of psychosis than their full siblings with normal vision (adjusted HR 1.20, 95% CI 1.07-1.35).
Impaired visual acuity is associated with non-affective psychosis. Visual impairment as a phenotype in psychosis requires further consideration.
本研究旨在探究青少年晚期视力障碍是否与日后发生精神病相关。
本研究为一项队列研究，共纳入 1974 年 1 月 1 日至 1997 年 12 月 31 日期间瑞典 18 或 19 岁的男性兵役人员 1140710 名。兵役登记时，测量了未经矫正和矫正视力（通过验光配镜）的远距视力。然后对参与者进行随访，以观察他们是否被诊断为非情感性精神病障碍（包括精神分裂症）（N=10769）。采用多变量 Cox 模型评估组间差异。
在调整混杂因素后，与未经矫正视力正常（十进制分数为 1.0）的个体相比，最佳眼未经矫正视力严重受损（十进制分数<0.3）的个体患精神病的风险更高（危险比[HR] 1.26，95%置信区间[CI] 1.16-1.37）。双眼视力差异越大，患精神病的风险越高（与双眼视力无差异者相比，差异>0.5 的个体 HR 为 1.49，95% CI 为 1.37-1.63）。无法通过镜片矫正至正常视力的个体视力受损率最高（最佳眼校正 HR 1.56；95%CI 1.33-1.82），视力有缺陷但可矫正的个体也有较高的发病率（最佳眼校正 HR 1.21；95%CI 1.15-1.28）。与视力正常的同胞相比，视力受损的个体患精神病的风险更高（校正 HR 1.20，95%CI 1.07-1.35）。
视力受损与非情感性精神病相关。精神病的视觉障碍表型需要进一步研究。
