Retinal layer structure on optical coherence tomography in post-traumatic stress disorder
Sejal D. Patel, Naveen Karthik, Grant A. Justin, Alice Haystead, Stephanie J. Chiu, Sandra S. Stinnett, Kim G. Johnson, Dilraj S. Grewal, Sharon FekratPurpose
To assess individual retinal layer thickness and volume changes on optical coherence tomography (OCT) in individuals with post-traumatic stress disorder (PTSD) compared to controls.
Methods
Adults ≥18 years with a PTSD diagnosis were identified. Age- and sex-matched controls (±5 years) without PTSD were recruited. Exclusion criteria included any cognitive disorder, brain injury, glaucoma, diabetes, optic nerve or vitreoretinal disease, uncontrolled hypertension, refractive error >±6 diopters, or best corrected visual acuity <20/40. Non-mydriatic OCT macular cube 512x128 images were obtained using Zeiss Cirrus HD-5000 AngioPlex. The Duke Reading Center DRCVisualizer software was used to segment the ganglion cell/inner plexiform (GC-IPL), inner nuclear (INL), outer plexiform (OPL), outer nuclear (ONL), photoreceptor, and retinal pigment epithelium (RPE) layers. Mean retinal thickness and volume were calculated for all layers within the central 1-mm subfield and 3- and 6-mm ETDRS rings, further divided into nasal, superior, temporal, and inferior quadrants.
Results
81 eyes of 42 PTSD patients and 81 eyes of 42 controls were analyzed. Average ages were 48 ± 15 years for PTSD and 51 ± 19 years for controls. Groups were 36% male. PTSD eyes showed significantly decreased photoreceptor thickness and volume and increased RPE thickness/volume across all ETDRS rings and quadrants (all p < 0.05). OPL thicknesses were decreased in PTSD eyes versus controls for temporal 3-mm (25.29 ± 1.36 µm vs. 26.64 ± 3.80µm) and temporal 6-mm (23.47 ± 0.88µm vs. 24.00 ± 1.54µm) rings (p < 0.05). OPL inferior 6-mm thickness was decreased in PTSD eyes (23.98 ± 1.58 µm vs. 24.78 ± 2.34 µm) versus controls (p < 0.05). The ONL nasal 6-mm thickness was decreased in PTSD versus controls (55.96 ± 7.90 µm vs. 56.74 ± 7.47µm) (p < 0.05). After adjusting for multiple testing, RPE differences remained significant across all evaluated regions, while photoreceptor differences remained significant within the central 1-mm and 3-mm ETDRS regions.
Conclusions
PTSD eyes demonstrated decreased photoreceptor layer and increased RPE thickness and volume.