The Early Visual System in Schizophrenia

Schizophrenia is often referred to as a cognitive disorder. A deeper and broader view of the syndrome is emerging, however, based on increasing appreciation of its associated visual system changes, including alterations in retinal neural and vascular structure and function, alterations in occipital lobe morphology and function, and their relationships with neuroinflammation and cardiometabolic factors. These and other data suggest that schizophrenia is best conceptualized as a multisystem condition. Here, we emphasize that early visual system changes in schizophrenia provide a window to the brain and to the rest of the body and provide valuable biomarkers for understanding pathophysiology and predicting multiple relevant outcomes, including the onset of a first psychotic episode, long-term course, and cognitive decline. The usefulness of early visual system markers of brain and physical health has already been demonstrated in neurodevelopmental and neurodegenerative disorders. They have particularly strong potential applicability for schizophrenia, given its progressive neurodevelopmental characteristics.