Retinal and choroidal vascular density alterations in patients with schizophrenia: assessment via optical coherence tomography angiography.

BACKGROUND: Previous studies have revealed the retinal and choroidal structural impairment in schizophrenia (SCZ). This study aimed to investigate alterations in retinal and choroidal vascular density in patients with SCZ using optical coherence tomography angiography (OCTA).​. METHODS: A total of 63 SCZ patients (63 eyes) and 61 healthy controls (61 eyes) were enrolled. Psychopathological symptoms in SCZ patients were assessed using the Positive and Negative Syndrome Scale (PANSS). OCTA images were acquired using an Optovue RTVue-XR system with a 3 × 3 mm scan size (304 × 304 pixels) to quantify the following parameters: retinal superficial vascular density (SVD), retinal deep vascular density (DVD), foveal avascular zone (FAZ), superficial FAZ (sFAZ), deep FAZ (dFAZ), choroidal vessel volume index (CVI), and choroidal vessel volume (CVV). Comparisons of retinal and choroidal vascular density were performed between the SCZ group and the control group. The diagnostic efficacy of these vascular density parameters in distinguishing SCZ patients from healthy controls was evaluated. Additionally, correlations between PANSS scores and retinal/choroidal vascular density parameters were analyzed in the SCZ group.​. RESULTS: Compared with the control group, the SCZ group exhibited significantly lower DVD (Z = -4.070, P < 0.001) and CVI (t = 2.204, P = 0.029), along with a significantly larger dFAZ (t = -3.953, P < 0.001). After adjusting for age, sex, and body mass index (BMI), DVD remained significantly associated with SCZ (β = -3.050, P = 0.011). Furthermore, the exploratory ROC analysis yielded an area under the curve (AUC) of 0.712 for DVD, indicating a modest level of discrimination between groups. Additionally, no significant correlations were observed between PANSS scores with DVD, dFAZ, or CVI in the SCZ group (all P > 0.05). CONCLUSION: These results suggest that alterations in retinal and choroidal vascular parameters, particularly DVD, may be associated with SCZ and have potential value as a potential exploratory marker for distinguishing SCZ patients from healthy controls. CLINICAL TRIAL NUMBER: Not applicable.