Retinal vascular abnormalities in schizophrenia and bipolar disorder: A window to the brain

Abhishek Appaji, Bhargavi Nagendra, Dona M. Chako, Ananth Padmanabha, Chaitra V. Hiremath, Arpitha Jacob, Shivarama Varambally, Muralidharan Kesavan, Ganesan Venkatasubramanian, Shyam V. Rao, Carroll A. B. Webers, Tos T. J. M. Berendschot, Naren P. Rao*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objectives The examination of retinal microvascular abnormalities through fundus photography is currently the best available non-invasive technique for assessment of cerebral vascular status. Several studies in the last decade have reported higher incidences of adverse cerebrovascular events in Schizophrenia (SCZ) and bipolar disorder (BD). However, retinal microvasculature abnormalities in SCZ and BD have remained under-explored, and no study has compared this aspect of SCZ and BD till date. Methods Retinal Images of 100 SCZ patients, BD patients, and healthy volunteers each were acquired by trained individuals using a non-mydriatic camera with a 40-degree field of view. The retinal images were quantified using a valid semi-automated method. The average of left and right eye diameters of the venules and arterioles passing through the extended zone between 0.5 and 2 disc diameters from the optic disc were calculated. Results The groups differed significantly with respect to average diameters of both retinal venules (P <0.001) and retinal arterioles (P <0.001), after controlling for age and sex. Both SCZ and BD patients had significantly narrower arterioles and wider venules compared to HV. There were also significant differences between SCZ and BD patients; patients with BD had narrower arterioles and wider venules. Conclusion Considering the affordability and easy accessibility of the investigative procedure, retinal microvascular examination could serve as a potential screening tool to identify individuals at risk for adverse cerebrovascular events. The findings of the current study also provide a strong rationale for further systematic examination of retinal vascular abnormalities in SCZ and BD.

Original languageEnglish
Pages (from-to)634-641
Number of pages8
JournalBipolar Disorders
Issue number7
Publication statusPublished - Nov 2019


  • cerebrovascular event
  • fundus
  • neurodevelopment
  • peripheral marker
  • psychoses
  • retinal vessel
  • RISK

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