Retinal and Choroidal Structural and Microvascular Characteristics in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Optical Coherence Tomography (OCT) and OCT Angiography (OCTA) Studies.

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that involves metabolic, hormonal, and inflammatory changes. These changes can affect tissues with high metabolic needs and sensitive microvascular systems. Optical coherence tomography (OCT) and OCT angiography (OCTA) are non-invasive ways to assess the structure and blood vessels of the retina and choroid. However, studies on women with PCOS have shown mixed results. This systematic review and meta-analysis set out to combine and analyze the available evidence on how PCOS affects retinal structure and microvasculature. We searched PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, and Google Scholar from inception to February 1, 2026, for observational studies comparing OCT and OCTA results in women with PCOS and healthy controls. The main outcomes were average peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and vessel density in the superficial and deep capillary plexus (SCP, DCP). We used the Newcastle-Ottawa Scale (NOS) to check study quality and the GRADE framework to rate the certainty of the evidence. We performed random-effects meta-analyses using mean differences (MDs) and 95% confidence intervals (CIs). We included 15 observational studies with a total of 1,370 women (737 with PCOS and 633 controls), and 13 studies were used in the quantitative analysis. Women with PCOS had a higher average RNFL thickness (MD +3.75 µm; 95% CI 2.48 to 5.01; moderate-certainty evidence) and a small but significant decrease in CMT (MD -3.29 µm; 95% CI -6.46 to -0.11; moderate certainty) compared to controls. SFCT was also higher overall (MD +58.03 µm), but there was a lot of variation between studies (I² = 99%). Subgroup analysis showed that SFCT thickening was only seen in studies where disease duration was not specified, while studies with newly diagnosed PCOS patients found no significant difference. There were no significant differences in SCP or DCP vessel density (low-certainty evidence).​ PCOS is linked to consistent changes in the retina and choroid, including thicker RNFL and thinner central macula, while the density of retinal blood vessels seems unchanged. Choroidal thickening was only found in groups where the length of disease was not specified, whereas the newly diagnosed showed no change. This shows that future studies should track disease duration over time to better understand these changes.