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Garcia-Martin, Elena, PhD*,†; Gavin, Alicia, MD*,†; Garcia-Campayo, Javier, PhD†,‡; Vilades, Elisa, OD*,†; Orduna, Elvira, OD*,†; Polo, Vicente, PhD*,†; Larrosa, Jose M., PhD*,†; Pablo, Luis E., PhD*,†; Satue, Maria, PhD*,†

doi: 10.1097/IAE.0000000000002252
Original Study: PDF Only

Purpose: To evaluate visual and retinal changes in patients with bipolar disorder. To analyze the correlation between structural changes and visual function parameters.

Methods: Thirty patients with bipolar disorder and 80 healthy controls underwent visual function evaluation with Early Treatment Diabetic Retinopathy Study charts at 100%, 2.50%, and 1.25% contrast, Pelli-Robson chart, and color vision Farnsworth and Lanthony tests. Analysis of the different retinal layers was performed using Spectralis optical coherence tomography with automated segmentation software. Correlation analysis between structural and functional parameters was conducted.

Results: Patients with bipolar disorder presented worse color vision compared with controls (Lanthony's index, P = 0.002). Full macular thickness, the retinal nerve fiber layer (RNFL), ganglion cell layer, and inner plexiform layer were reduced in patients compared with healthy individuals (P < 0.005). The inner nuclear layer was significantly thickened in patients (P < 0.005). Peripapillary RNFL thickness was reduced in all temporal sectors (P < 0.005). Significant correlations were found between visual acuity and the RNFL thickness, the Pelli-Robson score and the inner plexiform layer, and between the Lanthony's color index and the ganglion cell layer thickness.

Conclusion: Patients with bipolar disorder present quantifiable thinning of the macular RNFL, ganglion cell layer, and inner plexiform layer, as well as in the peripapillary RNFL thickness, and increasing thinning in the inner nuclear layer.

Visual and retinal changes were evaluated in patients with bipolar disorder. This study provides a complete analysis of all different retinal layers: the inner retinal layers were reduced in patients, except for the inner nuclear layer that was significantly augmented compared with healthy controls.

*Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain;

Miguel Servet Ophthalmology Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain; and

Department of Psychiatry, Miguel Servet University Hospital, Zaragoza, Spain.

Reprint requests: Maria Satue, PhD, C/Padre Arrupe, Consultas Externas de Oftalmología, 50009-Zaragoza, Spain; e-mail:

None of the authors has any financial/conflicting interests to disclose.

All subjects gave detailed consent to participate in this study, which was conducted in accordance with the guidelines established by the Ethics Committee of the Miguel Servet Hospital and based on the principles of the Declaration of Helsinki.

© 2018 by Ophthalmic Communications Society, Inc.