NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
Institute of Ophthalmology, University College London, London, United Kingdom.
JAMA Psychiatry. 2023 May 1;80(5):478-487. doi: 10.1001/jamapsychiatry.2023.0171.
The potential association of schizophrenia with distinct retinal changes is of clinical interest but has been challenging to investigate because of a lack of sufficiently large and detailed cohorts.
To investigate the association between retinal biomarkers from multimodal imaging (oculomics) and schizophrenia in a large real-world population.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used data from a retrospective cohort of 154 830 patients 40 years and older from the AlzEye study, which linked ophthalmic data with hospital admission data across England. Patients attended Moorfields Eye Hospital, a secondary care ophthalmic hospital with a principal central site, 4 district hubs, and 5 satellite clinics in and around London, United Kingdom, and had retinal imaging during the study period (January 2008 and April 2018). Data were analyzed from January 2022 to July 2022.
Retinovascular and optic nerve indices were computed from color fundus photography. Macular retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (mGC-IPL) thicknesses were extracted from optical coherence tomography. Linear mixed-effects models were used to examine the association between schizophrenia and retinal biomarkers.
A total of 485 individuals (747 eyes) with schizophrenia (mean [SD] age, 64.9 years [12.2]; 258 [53.2%] female) and 100 931 individuals (165 400 eyes) without schizophrenia (mean age, 65.9 years [13.7]; 53 253 [52.8%] female) were included after images underwent quality control and potentially confounding conditions were excluded. Individuals with schizophrenia were more likely to have hypertension (407 [83.9%] vs 49 971 [48.0%]) and diabetes (364 [75.1%] vs 28 762 [27.6%]). The schizophrenia group had thinner mGC-IPL (-4.05 μm, 95% CI, -5.40 to -2.69; P = 5.4 × 10-9), which persisted when investigating only patients without diabetes (-3.99 μm; 95% CI, -6.67 to -1.30; P = .004) or just those 55 years and younger (-2.90 μm; 95% CI, -5.55 to -0.24; P = .03). On adjusted analysis, retinal fractal dimension among vascular variables was reduced in individuals with schizophrenia (-0.14 units; 95% CI, -0.22 to -0.05; P = .001), although this was not present when excluding patients with diabetes.
In this study, patients with schizophrenia had measurable differences in neural and vascular integrity of the retina. Differences in retinal vasculature were mostly secondary to the higher prevalence of diabetes and hypertension in patients with schizophrenia. The role of retinal features as adjunct outcomes in patients with schizophrenia warrants further investigation.
精神分裂症与不同的视网膜变化之间存在潜在关联，这具有临床意义，但由于缺乏足够大且详细的队列，因此一直难以研究。
在一个大型真实世界人群中，调查多模态成像（眼动学）的视网膜生物标志物与精神分裂症之间的关联。
设计、设置和参与者：本横断面分析使用了来自 AlzEye 研究的 154830 名 40 岁及以上患者的回顾性队列数据，该研究将眼科数据与英格兰的医院入院数据进行了关联。患者在 Moorfields Eye Hospital 就诊，这是一家二级眼科医院，有一个主要的中央站点、4 个区域中心和 5 个位于伦敦及其周边地区的卫星诊所，在研究期间（2008 年 1 月至 2018 年 4 月）进行了视网膜成像。数据于 2022 年 1 月至 2022 年 7 月进行了分析。
从眼底彩色照相术计算出视网膜血管和视神经指数。从光学相干断层扫描中提取黄斑视网膜神经纤维层（mGC-IPL）和神经节细胞-内丛状层（mGC-IPL）厚度。使用线性混合效应模型来研究精神分裂症与视网膜生物标志物之间的关联。
在经过图像质量控制和排除潜在混杂因素后，共有 485 名（747 只眼）患有精神分裂症的个体（平均年龄[标准差]，64.9 岁[12.2]；258[53.2%]为女性）和 100931 名（165400 只眼）无精神分裂症的个体（平均年龄 65.9 岁[13.7]；53253[52.8%]为女性）被纳入分析。患有精神分裂症的个体更有可能患有高血压（407[83.9%] vs 49971[48.0%]）和糖尿病（364[75.1%] vs 28762[27.6%]）。精神分裂症组的 mGC-IPL 更薄（-4.05 μm，95%CI，-5.40 至-2.69；P=5.4×10-9），当仅调查无糖尿病的患者（-3.99 μm；95%CI，-6.67 至-1.30；P=0.004）或仅 55 岁及以下的患者时，这种情况仍然存在（-2.90 μm；95%CI，-5.55 至-0.24；P=0.03）。在调整分析中，患有精神分裂症的个体的血管变量中的视网膜分形维数降低（-0.14 个单位；95%CI，-0.22 至-0.05；P=0.001），尽管在排除患有糖尿病的患者时，这种情况并不存在。
在这项研究中，患有精神分裂症的患者的视网膜神经和血管完整性存在可测量的差异。视网膜血管的差异主要归因于精神分裂症患者中糖尿病和高血压的患病率更高。视网膜特征作为精神分裂症患者的附加结果的作用值得进一步研究。
