Visualizing Vascular Effects of Selective Serotonin Reuptake Inhibitors: An OCT Angiography Perspective

PURPOSE: To evaluate potential alterations in retinal microvasculature among users of selective serotonin reuptake inhibitors (SSRIs) using optical coherence tomography angiography (OCTA), and to compare the vascular effects across different SSRI subtypes. METHODS: This observational cross-sectional study included 111 patients on SSRIs for at least three months and 95 age- and gender-matched healthy controls. All participants underwent comprehensive ophthalmic examinations and OCTA imaging with a 3×3 mm macular scan. Vascular densities in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and foveal avascular zone (FAZ) area were quantified. RESULTS: Compared to controls, SSRI users exhibited significantly reduced vascular density in most regions of the SCP and all regions of the DCP (p < 0.01), along with an enlarged FAZ area. The duration of SSRI use showed a significant negative correlation with vascular density in multiple regions. Among different SSRIs, escitalopram users had significantly lower central DCP density compared to users of fluoxetine, paroxetine, and sertraline. CONCLUSION: Chronic use of SSRIs has been associated with measurable reductions in retinal vascular density and enlargement of the FAZ, which may reflect microvascular compromise. Escitalopram appears to demonstrate a more pronounced vascular effect in comparison to other selective serotonin reuptake inhibitors SSRIs. These findings highlight the significance of retinal vascular evaluation in patients undergoing long-term SSRI therapy.