Anksiyete Bozukluğu Hastalarında Santral Makula Kalınlığı ve Koroidal Vaskülarite İndeksinin Spektral-Domain Optik Koherens Tomografi ile Değerlendirilmesi

Abstract

Amaç: Yaygın anksiyete bozukluğu hastalarında spektral-domain optik koherens tomografi (SD-OKT) kullanarak santral makula kalınlığı (SMK) ve koroidal vaskülarite indeksinde (KVİ) potansiyel değişi-kliklerin araştırılması. Materyal ve Metod: Bu retrospektif karşılaştırmalı çalışmada yaşa göre eşleştirilmiş 85 katılımcı (38 yaygın anksiyete bozukluğu hastası, 47 sağlıklı kontrol) analiz edildi. Kapsamlı oftalmolojik muay-eneler ve geliştirilmiş derinlik görüntüleme (EDI) ile makular SD-OKT görüntülemesi yapıldı. SMK otomatik olarak ölçüldü, KVİ ise standart ImageJ binarizasyon protokolleri kullanılarak hesaplandı. İstatistiksel analizler bağımsız t-testleri, duyarlılık analizleri, etki büyüklüğü hesaplamaları ve korela-syon değerlendirmelerini içerdi (α = 0.05). Bulgular: Gruplar benzer demografik özellikler gösterdi (yaş p=0.492; cinsiyet p=0.659; göz içi basıncı p=0.472). SMK (249.4±20.5 µm karşı 246.0±32.5 µm; p=0.582; d=0.12) veya KVİ (70.3±3.3% karşı 70.5±3.6%; p=0.787; d=-0.06) açısından anlamlı fark bulunmadı. Duyarlılık analizleri (ilaçsız alt grup, sigara içmeyenler) ve anksiyete şiddeti korelasyonları tutarlı anlamlı olmayan sonuçlar verdi. Sonuç: Bu analiz yaygın anksiyete bozukluğunda posterior segment değişikliklerinin bulunmadığına dair kanıt sağladı ve mevcut psikofizyolojik modelleri sorguladı. Bulgular koroidin kronik strese karşı direncini vurgulamakta ve psikofizyolojik oftalmoloji araştırmalarında multimodal biomarker yak-laşımlarının gerekliliğini göstermektedir.

Keywords

• Generalized anxiety disorder
• Choroidal vascularity index
• Central macular thickness
• Optical coher-ence tomography
• Psychophysiology
• Biomarkers

Effects of Anxiety Disorder on Choroidal Vascularity Index and Central Macular Thickness: A Comprehensive Retrospective Analysis

Abstract

Materials and Methods: This retrospective comparative study analyzed 85 participants (38 general-ized anxiety disorder patients, 47 age- and sex-matched healthy controls). Comprehensive oph-thalmic examinations and macular SD-OCT imaging with enhanced depth imaging (EDI) were per-formed. CMT was measured automatically, while CVI was calculated using standardized ImageJ binarization protocols. Statistical analyses included independent t-tests, sensitivity analyses, effect size calculations, and correlation assessments (α = 0.05). Results: Groups demonstrated comparable demographics (age p=0.492; sex p=0.659; IOP p=0.472). No significant differences emerged in CMT (249.4±20.5 µm vs. 246.0±32.5 µm; p=0.582; Cohen's d=0.12) or CVI (70.3±3.3% vs. 70.5±3.6%; p=0.787; d=-0.06). Sensitivity analyses (medication-free subgroup, non-smokers) and anxiety severity correlations yielded consistent null findings. Conclusions: This robust analysis found no evidence of structural posterior segment alterations in generalized anxiety disorder, challenging prevailing psychophysiological models. Findings highlight the choroid's resilience to chronic stress and underscore the need for multimodal biomarker ap-proaches in psychophysiological ophthalmology research. Keywords: Generalized anxiety disorder, Choroidal vascularity index, Central macular thickness, Optical coherence tomography, Psychophysiology, Biomarkers

References

1. 1. Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: A systematic review and meta-regression. Psychol Med. 2013;43(5):897-910.
2. 2. Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009;5(7):374-81
3. 3. Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol 2012; 9:360–70. Available from: https://pubmed.ncbi.nlm.nih.gov/22473079/
4. 4. Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye Res. 2010;29(2):144-68.
5. 5. Kiel JW. Choroidal myogenic autoregulation and intraocular pressure. Exp Eye Res. 1994;58(5):529-43..
6. 6. Harvey DH, Sugali CK, Mao W. Glucocorticoid-Induced Ocular Hypertension and Glaucoma. Clin Ophthalmol. 2024;18:481-505.
7. 7. Agrawal R, Gupta P, Tan KA, Cheung CM, Wong TY, Cheng CY. Choroidal vascularity index as a measure of vascular status of the choroid: Measurements in healthy eyes from a population-based study. Sci Rep. 2016;6:21090.
8. 8. London A, Benhar I, Schwartz M. The retina as a window to the brain-from eye research to CNS disorders. Nat Rev Neurol. 2013;9(1):44-53.

9. 9. Ayyildiz D, Ayyildiz T. Central choroidal thickness in children and adolescents with anxiety disorders: enhanced depth imag-ing optical coherence tomography findings. Int J Ophthalmol. 2020;13(10):1580-1585.
10. 10. Acan D, Baykan H, Karahan E. Evaluation of retinal and cho-roidal vascular structures in patients with anxiety disorder. Eur J Ophthalmol 2024; 34:1211–6.
11. 11. Ozisik GG, Kiraz S. Evaluation of retinal thickness measured by optical coherence tomography in patients with generalized anxiety disorder. Photodiagnosis Photodyn Ther 2023; 44:103766.
12. 12. Baykara S, Kazğan A, Yıldırım H, Tabara MF, Kaşıkcı HÖ, Danacı Keleş D. Retinal changes in generalized anxiety disorder pa-tients. Int J Psychiatry Med 2024; 59:270–86.
13. 13. Lin J, Han Y, Liu M, Wang X. Effects of Acute Mental Stress on Choroidal Thickness. Bioengineering 2024; 11:684.
14. 14. Schmetterer L, Polak K. Role of nitric oxide in the control of ocular blood flow. Prog Retin Eye Res 2001;20:823–47.
15. 15. Wang Y, Liu L, Li C, Yang Y, He X, Jiang M, et al. Choroidal vessel density in major depressive disorder using swept-source optical coherence tomography angiography. J Affect Disord 2024; 344:79–85.
16. 16. Tan KA, Laude A, Yip V, Loo E, Wong EP, Agrawal R. Choroidal vascularity index – a novel optical coherence tomography pa-rameter for disease monitoring in diabetes mellitus? Acta Ophthalmol. 2016; 94:e612–6.
17. 17. Yang TK, Huang XG, Yao JY. Effects of Cigarette Smoking on Retinal and Choroidal Thickness: A Systematic Review and Me-ta-Analysis. J Ophthalmol 2019; 2019:8079127.
18. 18. Ikuno Y, Maruko I, Yasuno Y, Miura M, Sekiryu T, Nishida K, et al. Reproducibility of retinal and choroidal thickness meas-urements in enhanced depth imaging and high-penetration optical coherence tomography. Invest Ophthalmol Vis Sci. 2011;52:5536–40.
19. 19. Galor A, Felix ER, Feuer W, Shalabi N, Martin ER, Margolis TP, et al. Dry eye symptoms align more closely to non-ocular con-ditions than to tear film parameters. Br J Ophthalmol. 2015;99(8):1126-9.
20. 20. Alkozi HA. Ocular Surface Health in Connection with Anxiety and Depression: a Review. J Multidiscip Healthc 2024; 17:2671-2676.
21. 21. Jesus J, Ambrósio J, Meira D, Rodriguez-Uña I, Beirão JM. Blinded by the Mind: Exploring the Hidden Psychiatric Burden in Glaucoma Patients. Biomedicines 2025;13(1):116.