Study Underscores Need for Eye Exam in Psych Disorders

Medscape

5 days ago

Individuals older than 50 years with bipolar or major depressive disorder were more likely to have retinal disease, and those with a diagnosis of retinal disease and a psychiatric illness were at sharply higher risk for impaired vision than those with retinal disease alone.
METHODOLOGY:
Researchers conducted a retrospective cohort analysis of adults aged 50-89 years with a diagnosis of schizophrenia (n = 160,414; mean age, 65 years), bipolar disorder (n = 391,440; mean age, 63 years), or major depressive disorder (n = 1,962,380; mean age, 67 years), matched with people without psychiatric conditions.
They also examined how comorbid psychiatric disorders affected vision impairment in patients with retinal disease, focusing on those with schizophrenia (n = 8880), bipolar disorder (n = 22,678), or major depressive disorder (n = 265,544); these patients were matched to individuals with retinal disease but no history of psychiatric disorders.
The primary outcome was a diagnosis of retinal disease, including chronic or age-related conditions, and the secondary outcome was having impaired vision.
TAKEAWAY:
Individuals with bipolar disorder showed a 4%-15% higher risk for retinal disease across all age groups older than 60 years (relative risk [RR], 1.04; 95% CI, 1.01-1.08 for ages 60-69 years; RR, 1.15; 95% CI, 1.10-1.20 for ages 70-79 years; and RR, 1.15; 95% CI, 1.07-1.23 for ages 80-89 years).
Major depressive disorder also was associated with an increased likelihood of retinal disease in people aged 50-59 years (RR, 1.84; 95% CI, 1.79-1.89), with sustained increase in risk among those aged 60-69 years, 70-79 years, and 80-89 years.
Among individuals with retinal disease, those with a diagnosis of major depressive disorder were about 50% more likely to have impaired vision (RR, 1.51; 95% CI, 1.48-1.54) as were those with a diagnosis of bipolar disorder (RR, 1.33; 95% CI, 1.25-1.42).
While individuals with schizophrenia were less likely to be diagnosed with retinal disease (RR < 1 across all age groups), those who had both schizophrenia and retinal disease were 35% more likely to experience impaired vision as were those with retinal disease alone (RR, 1.35; 95% CI, 1.23-1.48).
IN PRACTICE:
'Individuals with psychiatric disorders are often considered a vulnerable population due to systemic, social, and biologic factors that contribute to worse health outcomes compared to the general population,' the authors of the study wrote. 'Psychiatric disorders are also associated with comorbidities such as obesity, diabetes, and metabolic syndrome that are known to increase risk of retinal disease such as diabetic retinopathy. Our findings suggest the need for closer monitoring of retinal disease and visual impairment in individuals with psychiatric disorders.'
SOURCE:
This study was led by Jeffrey Chu of the Case Western Reserve University School of Medicine in Cleveland. It was published online on May 20, 2025, in Eye .
LIMITATIONS:
The retrospective nature of this study and potential variations in coding practices among clinicians and institutions limited the findings. Data for optical coherence tomography and visual acuity were unavailable in the network database. Additionally, unaccounted variables such as use of medication, duration of psychiatric disorders, lifestyle factors like smoking, socioeconomic status, and healthcare access may have introduced confounding effects that could not be controlled for.
DISCLOSURES:
This study received support from the Clinical and Translational Science Collaborative through a National Institutes of Health grant, along with partial support from some other sources. Some authors disclosed receiving personal fees, research fees, consulting fees, and speaking fees from several pharmaceutical companies.