Abstract
BackgroundWe aimed to determine whether late adolescent visual impairment is associated with later psychosis.MethodsWe conducted a longitudinal cohort study of Swedish male military conscripts aged 18 or 19 years from January 1, 1974, through December 31, 1997 (N = 1140710). At conscription, uncorrected and optometry-lens-corrected distance visual acuity was measured. Participants were then followed up to see if they received an inpatient diagnosis of non-affective psychotic disorder, including schizophrenia (N = 10769). Multivariable Cox modeling was used to estimate differences between groups.ResultsAfter adjustment for confounders, those with severe impairment before optical correction in their best eye (decimal fraction <0.3) had an increased psychosis rate compared to those with normal uncorrected vision (decimal fraction 1.0) (hazard ratio [HR] 1.26, 95% CI 1.16–1.37). Larger interocular visual acuity difference was associated with an increased psychosis rate (adjusted HR 1.49, 95% CI 1.37–1.63 in those with differences >0.5 compared to those with no between eye acuity difference). Individuals with impaired vision that could not be corrected to normal with lenses had highest rates of psychosis (best eye adjusted HR 1.56; 95% CI 1.33–1.82), those with imperfect, but correctable vision also had elevated rates (best eye adjusted HR 1.21; 95% CI 1.15–1.28). Individuals with visual impairment had higher rates of psychosis than their full siblings with normal vision (adjusted HR 1.20, 95% CI 1.07–1.35).ConclusionsImpaired visual acuity is associated with non-affective psychosis. Visual impairment as a phenotype in psychosis requires further consideration.
Highlights
Visual deficits have been identified at all clinical stages of psychotic illness in increasing severity, from high risk,[1,2] and prodromal states,[3] through first episode,[4] to chronic schizophrenia.[5,6] As such, it has been suggested that visual defects represent a phenotype which could contribute to more reliable diagnostic criteria for schizophrenia.[7]One important measure of visual function is acuity
One study in offspring of mothers with psychosis found that visual dysfunction aged 4 was associated with schizophrenia-spectrum disorders at 22.1 In another cohort with family history of psychosis, visual dysfunction before age 13 was associated with psychosis aged 33.2 Both of these studies were small and did not account for any potential confounders
Individuals who had admissions for serious mental illness (SMI) including bipolar disorder, schizoaffective disorder, schizophrenia or other psychotic illness, before their conscription interview were excluded from the analysis, as were individuals who were assessed as having psychosis at the conscription interview
Summary
Visual deficits have been identified at all clinical stages of psychotic illness in increasing severity, from high risk,[1,2] and prodromal states,[3] through first episode,[4] to chronic schizophrenia.[5,6] As such, it has been suggested that visual defects represent a phenotype which could contribute to more reliable diagnostic criteria for schizophrenia.[7]One important measure of visual function is acuity. Visual acuity is a composite measure of the capacity for the eye to accurately focus light on the retina, the integrity of the retina, and the brains ability to interpret the information provided.[8] While neurological abnormalities have long been a focus of interest in the aetiology of psychosis, it is only more recently via techniques such as electroretinography and optical coherence tomography, that cross-sectional associations between retinal anomalies and schizophrenia have been identified.[6] Myopia is the most common cause of reduced distance acuity and affects over 20% of the world’s population.[9] Despite the high prevalence of abnormal acuity and the apparent increase in visual deficits as psychotic illness progresses,[4,5,10] very little research has examined the potential relationship between visual acuity and psychosis longitudinally, or on a population-level. Results: After adjustment for confounders, those with severe impairment before optical correction in their best eye (decimal fraction
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