Choroidal Changes From Schizophrenia, Bipolar Disorder Differ Between Sexes

Optical coherence tomography
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Psychotic illnesses can affect choroidal thickness, choroidal vascular volume, and choroid vascular density, but these changes vary dependent on patient sex.

Among patients with psychosis, the pathogenesis of psychotic illness affects the choroidal microvascular differently depending upon their sex, evidence from a cross-sectional pilot published in Clinical Ophthalmology suggests.

The study took into account 32 participants from the Bipolar and Schizophrenia Network on Intermediate Phenotype-2 (B-SNIP2) and another 19 patients as a healthy control group from 3 centers in Boston. The study participants underwent swept-source optical coherence tomography angiography (SS-OCT-A) and choroidal characteristics were compared between groups.

The participants in the study and control group had a median age of 34.5 (IQR, 25.0-46.0) and 34 (IQR, 28.0-47.0) years, respectively. Demographics collected from the 2 groups also show that they were 34.4% and 31.6% women, and 50.0% and 68.4% White, respectively. Participants in the study and control groups had BMIs of 29.5 (IQR, 24.8-34.2) and 25.9 (IQR, 22.4-31.2) kg/m2, and best-corrected visual acuities (BCVA) of 0.05 (IQR, 0.00-0.21) and 0.00 (IQR, 0.00-0.17) logMAR, respectively.

The participants in the case group were diagnosed with schizophrenia (n=18), schizoaffective disorder (n=9), and psychotic bipolar disorder (n=5).

The participants in the case group had greater maximum choroidal thickness (CT; median, 330 vs 318 μm) and choroidal vascular volume (CVV; median, 6.94 vs 6.67 mm3) and lower average choroid vascular density (CVD; median, 19.4% vs 19.7%) than those in the control group.

Overall, CT, CVV, and CVD did not differ significantly on the basis of group, age, or body mass index (BMI).

Stratified by sex, men differed for average CVD (β, -0.51; P =.006) and women differed for maximum CT (β, -86.9; P =.03) and CVV (β, -1.80; P =.02). However, among controls, men and women also differed significantly for maximum CT (β, 75.2; P =.04) and CVV (β, 1.48; P =.047).

The major limitation of this study was to include multiple types of psychotic diagnoses. Additional, larger studies are needed to evaluate whether specific changes are associated with particular types of psychosis.

“The differences we describe may be due to unequal time since diagnosis in [men v women], as by the median age of 33-38 years, [men] are likely to have been symptomatic for several more years,” the researchers explain. “Another possibility is differing amount and length of antipsychotic use among [men v women], given that increasing dose and duration of antipsychotic use is associated with worse cortical volume loss in psychosis patients. Of note, we did not find that adjusting for the length of illness or duration of treatment with antipsychotics correlated significantly with max CT, CVD, or CVV.”

Disclosure: Multiple authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. . Please refer to the original article for a full list of disclosures.


Li CY, Garg I, Bannai D, et al. Sex-specific changes in choroid vasculature among patients with schizophrenia and bipolar disorder. Clin Ophthalmol. 2022;16:2363-2371. doi:10.2147/OPTH.S352731