Examination of retinal vascular trajectory in schizophrenia and bipolar disorder

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

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Aim: Evidence suggests microvascular dysfunction (wider retinal venules and narrower arterioles) in schizophrenia (SCZ) and bipolar disorder (BD). The vascular development is synchronous with neuronal development in the retina and brain. The retinal vessel trajectory is related to retinal nerve fiber layer thinning and cerebrovascular abnormalities in SCZ and BD and has not yet been examined. Hence, in this study we examined the retinal vascular trajectory in SCZ and BD in comparison with healthy volunteers (HV). Methods: Retinal images were acquired from 100 HV, SCZ patients, and BD patients, respectively, with a non-mydriatic fundus camera. Images were quantified to obtain the retinal arterial and venous trajectories using a validated, semiautomated algorithm. Analysis of covariance and regression analyses were conducted to examine group differences. A supervised machine-learning ensemble of bagged-trees method was used for automated classification of trajectory values. Results: There was a significant difference among groups in both the retinal venous trajectory (HV: 0.17 ± 0.08; SCZ: 0.25 ± 0.17; BD: 0.27 ± 0.20; P < 0.001) and the arterial trajectory (HV: 0.34 ± 0.15; SCZ: 0.29 ± 0.10; BD: 0.29 ± 0.11; P = 0.003) even after adjusting for age and sex (P < 0.001). On post-hoc analysis, the SCZ and BD groups differed from the HV on retinal venous and arterial trajectories, but there was no difference between SCZ and BD patients. The machine learning showed an accuracy of 86% and 73% for classifying HV versus SCZ and BD, respectively. Conclusion: Smaller trajectories of retinal arteries indicate wider and flatter curves in SCZ and BD. Considering the relation between retinal/cerebral vasculatures and retinal nerve fiber layer thinness, the retinal vascular trajectory is a potential marker for SCZ and BD. As a relatively affordable investigation, retinal fundus photography should be further explored in SCZ and BD as a potential screening measure.

Original languageEnglish
Pages (from-to)738-744
Number of pages7
JournalPsychiatry and Clinical Neurosciences
Issue number12
Early online date10 Aug 2019
Publication statusPublished - 1 Dec 2019


  • bipolar disorder
  • machine learning
  • retinal nerve fiber layer
  • retinal vascular trajectory
  • schizophrenia


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