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Sheehan N, Bannai D, Silverstein SM, Lizano P. Neuroretinal Alterations in Schizophrenia and Bipolar Disorder: An Updated Meta-analysis. Schizophr Bull 2024; 50:1067-1082. [PMID: 38954839 PMCID: PMC11349028 DOI: 10.1093/schbul/sbae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Schizophrenia (SZ) and bipolar disorder (BD) are characterized by major symptomatic, cognitive, and neuroanatomical changes. Recent studies have used optical coherence tomography (OCT) to investigate retinal changes in SZ and BD, but their unique and shared changes require further evaluation. Articles were identified using PubMed and Google Scholar. 39 studies met the inclusion criteria. Diagnostic groups were proband (SZ/BD combined), SZ, BD, and healthy control (HC) eyes. Meta-analyses utilized fixed and random effects models when appropriate, and publication bias was corrected using trim-and-fill analysis ("meta" package in R). Results are reported as standardized mean differences with 95% CIs. Data from 3145 patient eyes (1956 SZ, 1189 BD) and 3135 HC eyes were included. Studies identified thinning of the peripapillary retinal nerve fiber layer (pRNFL, overall and in 2 subregions), m-Retina (overall and all subregions), mGCL-IPL, mIPL, and mRPE in SZ patients. BD showed thinning of the pRNFL (overall and in each subregion), pGCC, and macular Retina (in 5 subregions), but no changes in thickness or volume for the total retina. Neither SZ nor BD patients demonstrated significant changes in the fovea, mRNFL, mGCL, mGCC, mINL, mOPL, mONL, or choroid thicknesses. Moderating effects of age, illness duration, and smoking on retinal structures were identified. This meta-analysis builds upon previous literature in this field by incorporating recent OCT studies and examining both peripapillary and macular retinal regions with respect to psychotic disorders. Overall, this meta-analysis demonstrated both peripapillary and macular structural retinal abnormalities in people with SZ or BD compared with HCs.
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Affiliation(s)
- Nora Sheehan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Deepthi Bannai
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Xiao Q, Li F, Jiang F, Zhang Z, Xu B. The prospects for early detection with optical coherence tomography (OCT) and OCT angiography in major depressive disorder. J Affect Disord 2024; 347:8-14. [PMID: 37984693 DOI: 10.1016/j.jad.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Research has shown the diagnostic potential of optical coherence tomography (OCT) and OCT angiography (OCTA) in various psychiatric disorders. However, there is few research focusing on changes specific to Major Depressive Disorder (MDD), and the diagnostic value of OCT combined with OCTA parameters for MDD remains unclear. METHODS In this study, we investigated microvascular and morphology changes in the retina of MDD patients using a combination of OCTA and OCT parameters, and to examine their correlation with MDD mood and cognitive function in order to assess their diagnostic capability. RESULTS Our findings revealed a significant decline in macular vessel density (MVD) in the superficial retinal capillary plexus (SRCP) across all subfields, except the NO area. We also observed a significant positive correlation between fovea and Stroop-1, as well as between temporal inner (TI) and Stroop-3 in MDD patients. Furthermore, we identified a negative correlation between fovea and Self-Rating Depression Scale, as well as between Superior outer (SO) and Difficulties in Emotion Regulation Scale-C in MDD patients. LIMITATIONS The sample size was small. Anatomical variables in blood flow may contribute to variability between subjects and outcomes. CONCLUSIONS The diagnostic value of OCTA suggests their potential as valuable tools for monitoring and diagnosing MDD.
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Affiliation(s)
- Qian Xiao
- Mental Health Center of Xiangya Hospital, Central South University, Changsha 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fangling Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; Eye Center of Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China; National Key Clinical Ophthalmology Specialist, Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Branch of the National Clinical Medical Research Center for Eye Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Furong Jiang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhejia Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Bei Xu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; Eye Center of Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China; National Key Clinical Ophthalmology Specialist, Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Branch of the National Clinical Medical Research Center for Eye Diseases, Xiangya Hospital, Central South University, Changsha, China.
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Prasannakumar A, Kumar V, Mailankody P, Appaji A, Battu R, Berendschot TTJM, Rao NP. A systematic review and meta-analysis of optical coherence tomography studies in schizophrenia, bipolar disorder and major depressive disorder. World J Biol Psychiatry 2023; 24:707-720. [PMID: 37070475 DOI: 10.1080/15622975.2023.2203231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Due to the common neurodevelopmental origin and easy accessibility, the retina serves as a surrogate marker for changes in the brain. Hence, Optical Coherence Tomography (OCT), a tool to examine the neuronal layers of retina has gained importance in investigating psychiatric disorders. Several studies in the last decade have reported retinal structural alterations in schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD). However, the findings are inconsistent. Hence, we conducted a meta-analysis to investigate alterations in OCT parameters in patients with SCZ, BD and MDD. METHODS We searched electronic databases for studies that examined OCT parameters in patients with SCZ, BD and MDD published up to January 2023. The primary outcome measures were thickness and volumes of the retinal Nerve Fibre Layer (RNFL). We conducted meta-analysis using a random effects model. RESULTS The searches yielded 2638 publications of which 43 studies were included in the final analysis across all disorders. Compared to controls, the RNFL was thinner in SCZ patients (SMD = -0.37, p = <0.001) and BD patients (SMD = -0.67, p = < 0.001), but not in MDD patients (SMD = -0.08, p = 0.54). On quadrant wise analysis, temporal quadrant RNFL was thinner in SCZ but not in BD, while all other quadrants were thinner in both SCZ and BD. CONCLUSION We found significant reductions in RNFL thickness in SCZ and BD, but not in MDD. The differential involvement in various quadrants and parameters across the disorders has potential implications for using retinal parameters as a diagnostic biomarker.
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Affiliation(s)
- Akash Prasannakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Abhishek Appaji
- Department of Medical Electronics, BMS College of Engineering, Bangalore, Karnataka, India
- Department of Opthalmology, University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rajani Battu
- Department of Opthalmology, Centre for Eye Genetics and Research, Bangalore, Karnataka, India
| | - Tos T J M Berendschot
- Department of Opthalmology, University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Xiao X, Zhong D, Liu H, Fan R, Jiang C, Zheng Z, Li Y, Wan L. Role of optical coherence tomography in depression detection: a protocol of systematic review and meta-analysis. BMJ Open 2023; 13:e065549. [PMID: 37423631 DOI: 10.1136/bmjopen-2022-065549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Optical coherence tomography (OCT) is a non-invasive approach for detecting changes in the retinal layers, which may also reflect changes in brain structure and function. As one of the leading causes of disability worldwide, depression has been associated with alteration of brain neuroplasticity. However, the role of OCT measurements in detecting depression remains unknown. This study aims to employ a systematic review and meta-analysis approach to explore ocular biomarkers measured by OCT for detecting depression. METHODS AND ANALYSIS We will search studies describing the relationship between OCT and depression across seven electronic databases, and retrieve articles published from database inception to date. We will also manually search grey literature and reference lists included in the retrieved studies. Two independent reviewers will screen studies, extract data and assess risk of bias. Target outcomes will include peripapillary retinal nerve fibre layer thickness, macular ganglion cell complex thickness and macular volume, as well as other related indicators. Next, we will conduct subgroup analysis and meta-regression to explore study heterogeneity, then perform sensitivity analysis to investigate the robustness of the synthesised results. Meta-analysis will be performed using Review Manager (V.5.4.1) and STATA (V.12.0), and the certainty of evidence will be graded according to the Grading of Recommendations Assessment, Development and Evaluation system. ETHICS AND DISSEMINATION Ethics approval is not necessary because the data used in this systematic review and meta-analysis will be extracted from published studies. Study results will be disseminated by publishing our findings in a peer-reviewed journal.
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Affiliation(s)
- Xili Xiao
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huan Liu
- Department of Rehabilitation Medicine, Nanbu County People's Hospital, Nanchong, China
| | - Rong Fan
- Department of Rehabilitation Medicine, Nanbu County People's Hospital, Nanchong, China
| | - Chengzhi Jiang
- Department of Rehabilitation Medicine, Sichuan Science City Hospital, Mianyang, China
| | - Zhong Zheng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li Wan
- School of sports medicine and health, Chengdu Sport University, Chengdu, China
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Xiong K, Gong X, Xie L, Wang L, Guo X, Li W, Zhong P, Liang X, Huang W, Wang W. Influence of Serum Uric Acid on Macular Choroidal Thickness and Ganglion Cell Inner Plexiform Layer Thickness. Transl Vis Sci Technol 2023; 12:13. [PMID: 37171795 PMCID: PMC10184778 DOI: 10.1167/tvst.12.5.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Purpose The purpose of this study was to determine the influence of serum uric acid (UA) on macular choroidal and ganglion cell inner plexiform layer (GC-IPL) thickness. Methods This cross-sectional study enrolled adult individuals in communities in Guangzhou, China. All participants underwent a comprehensive ophthalmologic examination. They were divided into four groups according to UA quartiles. The choroidal and GC-IPL thickness was measured by swept-source optical coherence tomography (SS-OCT). Results A total of 719 subjects (1389 eyes) were included in the study. The average UA was 348.50 ± 86.16 mmol/L. The average choroidal and GC-IPL thickness decreased with UA quartiles (P < 0.001). Multivariate linear regression analyses showed that UA was negatively associated with average choroidal (β = -0.073, 95% confidence interval [CI] = -0.117 to -0.028, P = 0.001) and GC-IPL thickness (β = -0.006, 95% CI = -0.009 to -0.002, P = 0.001). After adjusting for confounding factors, the average choroidal thickness was decreased in quartile 4 as compared with quartile 1 by -14.737 µm (95% CI = -24.460 to -5.015, P = 0.003). The average GC-IPL thickness was decreased in quartile 4 versus quartile 1 by -1.028 (95% CI = -1.873 to -0.290, P = 0.007). Conclusions Higher UA levels were independently associated with macular choroid and GC-IPL thinning. These contribute to a better understanding of ocular pathological mechanisms. Translational Relevance The associated UA with choroidal and GC-IPL thickness helps to understand the ocular pathological and retinal neurodegenerative mechanism.
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Affiliation(s)
- Kun Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xia Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Liqiong Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lanhua Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiao Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Pingting Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Liu Y, Chen J, Huang L, Yan S, Gao D, Yang F. Association between changes in the retina with major depressive disorder and sleep quality. J Affect Disord 2022; 311:548-553. [PMID: 35598744 DOI: 10.1016/j.jad.2022.05.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is linked to degenerative and inflammatory processes in the brain. The retina, as well as the brain, originates from the ectoderm. The changes in the retina that occur in concert with MDD and sleep quality are not very clear. This study aimed to detect changes in the retinal nerve fibre layer (RNFL) and macular thickness in Chinese patients in correlation with MDD and sleep quality. METHODS Thirty-six MDD patients and 187 age- and sex-matched healthy controls were enrolled in this study. All subjects were scanned by spectral-domain optical coherence tomography (OCT) and completed the Stroop Colour-Word Test (SCWT), Pittsburgh Sleep Quality Index, and Patient Health Questionnaire-9. RESULTS The RNFL and macular thickness were significantly thinner and disc-area enlargement of the right eye and cup-volume enlargement of both eyes were present in MDD patients. Linear regression analysis revealed that the RNFL and macular thickness in patients with MDD were correlated with sleep quality and the severity of depression. SCWT scores were higher following expansion of the cup volume of the right eye (all p < 0.01) and in correlation with larger disc areas. CONCLUSIONS Serious degrees of depression and insomnia in MDD patients may reflect obvious atrophy of the inner and outer rings of the right macula and enlargement of the optic disc in both eyes. These retinal structural changes might influence the visual cognition of patients with MDD.
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Affiliation(s)
- Yanhong Liu
- Huilongguan Clinical Medical School, Peking University, Beijing, China; Beijing Huilongguan Hospital, Beijing, China
| | - Jingxu Chen
- Huilongguan Clinical Medical School, Peking University, Beijing, China; Beijing Huilongguan Hospital, Beijing, China
| | - Lvzhen Huang
- People's Hospital of Peking University, Beijing, China
| | - Shaoxiao Yan
- Huilongguan Clinical Medical School, Peking University, Beijing, China; Beijing Huilongguan Hospital, Beijing, China
| | - Dongfang Gao
- Huilongguan Clinical Medical School, Peking University, Beijing, China; Beijing Huilongguan Hospital, Beijing, China
| | - Fude Yang
- Huilongguan Clinical Medical School, Peking University, Beijing, China; Beijing Huilongguan Hospital, Beijing, China.
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Combined influence of medication and symptom severity on visual processing in bipolar disorder. J Psychiatr Res 2022; 147:135-141. [PMID: 35032946 DOI: 10.1016/j.jpsychires.2022.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
Abstract
Previous studies have reported visual impairments in patients with bipolar disorder (BPD), but unclear were whether clinical variables would be associated with those disturbances. Here, we investigate the relationship between visual functioning, in terms of color discrimination, and the impact of BPD duration, mood state, and the patients' medication. Forty-five participants (25-45 years old) were recruited for this study. Color discrimination was performed using the Cambridge Colour Test. Serial multiple mediations were run to investigate the assumption of association between color discrimination and the clinical variables. Our findings showed that, compared with healthy controls, BPD patients' performance was worse for the Protan, Deutan, and Tritan vectors, revealing deterioration of color discrimination. In addition, the mediation analyses revealed a strong direct (p < .001) and moderate-to-high indirect effects (p < .01) of medication and symptom severity on color discrimination. Overall, both longer the duration of the disease and greater the symptom severity of BPD patients resulted in worse performance. It highlights the importance of examining the wider clinical context of an affective disorder to understand how it affects visual processing in this population.
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Liu X, Lai S, Ma S, Yang H, Liu L, Yu G, Zhong S, Jia Y, Zhong J. Development of a Novel Retina-Based Diagnostic Score for Early Detection of Major Depressive Disorder: An Interdisciplinary View. Front Psychiatry 2022; 13:897759. [PMID: 35664496 PMCID: PMC9162334 DOI: 10.3389/fpsyt.2022.897759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clinically effective markers for the diagnosis of major depressive disorder (MDD) are lacking. Alterations in retinal features are closely related to the pathophysiological progression of MDD. However, the reliable retina-related diagnostic model for MDD remains to be developed. Thus, our study aimed to quantitatively evaluate retinal vascular and structural changes in MDD patients and to develop a reliable diagnostic model of MDD based on retinal parameters. METHODS Seventy-eight patients with MDD and 47 healthy controls (HCs) underwent retinal vessel density and structure examination using optical coherence tomography angiography and visual field examination using perimetry. Independent-sample t test was used to assess the differences in retinal parameters between the groups. Meanwhile, we constructed the corresponding retina-based diagnostic model by LASSO logistic regression. Finally, the diagnostic ability of the model was evaluated by area under the curve (AUC) of receiver operating characteristic curves and calibration plot of nomogram. RESULTS MDD patients showed lower retinal vessel density (including radial peripapillary capillary vessel density, superficial and deep capillary plexus vessel density), thinner subfoveal choroidal thickness, and poorer visual fields compared to HCs (all p < 0.05). Furthermore, a retina-based diagnostic model was constructed and shows a strong diagnostic capability for MDD (AUC = 0.9015, p < 0.001). CONCLUSION Patients with MDD showed distinct retinal features compared to HCs. The retina-based diagnostic model is expected to be a necessary complement to the diagnosis of MDD.
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Affiliation(s)
- Xiao Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shunkai Lai
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shisi Ma
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hong Yang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lian Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guocheng Yu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuming Zhong
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanbin Jia
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jingxiang Zhong
- Department of Ophthalmology, The Sixth Affiliated Hospital of Jinan University, Dongguan, China.,Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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