Posttraumatic Stress Disorder and Macular, Choroidal, and Peripapillary Perfusion Using Optical Coherence Tomography and Angiography

BACKGROUND AND OBJECTIVE: Posttraumatic stress disorder (PTSD) is a chronic psychiatric condition associated with long-term neurobiological and neurovascular changes. In this study, optical coherence tomography (OCT) and OCT angiography (OCTA) were used to assess macular, choroidal, and peripapillary architecture and microvasculature in patients with PTSD. PATIENTS AND METHODS: Patients with a documented history of PTSD and age-and sex-matched controls were recruited. OCT and OCTA parameters were measured using the Zeiss Cirrus HD-5000 Spectral-Domain OCT with AngioPlex. Primary outcome measure was the associations between differences in OCT and OCTA parameters and PTSD. Secondary outcome measures were the association of OCT and OCTA parameters and other mental illnesses including depression, anxiety, and bipolar disorder, and history of migraine or traumatic brain injury (TBI). RESULTS: Fifty-nine eyes of 32 PTSD patients and 64 eyes of 32 control patients were included. PTSD participants had significantly lower 3 × 3-mm macular perfusion density (PD) and vessel density (VD) (all P ≤ .001), and foveal avascular zone circularity (P < .001) compared to controls. For PTSD subjects with a history of TBI versus those without, there were no significant differences across macular, choroidal, or peripapillary perfusion measurements. However, for PTSD subjects with a history of migraine, there were significantly decreased PD and VD in the 6 × 6-mm circle and inner ring. For associated mental illnesses, there were no differences between PTSD subjects with and without depression, anxiety, or bipolar disorder. CONCLUSION: Decreased macular perfusion was noted in patients with PTSD. Further investigation is needed to evaluate OCT and OCTA imaging as a noninvasive modality for screening and assessing interventions in patients with PTSD.