Retinal layer structure on optical coherence tomography in post-traumatic stress disorder

PURPOSE: 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.