Patients with polycystic ovary syndrome had measurable retinal structural differences compared with healthy controls, including thicker retinal nerve fiber layers and slightly thinner central macula, according to a systematic review and meta-analysis of ophthalmic imaging studies published in Cureus.

The analysis synthesized observational studies using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to evaluate retinal and choroidal structure and microvascular density in patients with polycystic ovary syndrome (PCOS). Investigators pooled data from 15 studies comprising 1,370 women, including 737 patients with PCOS and 633 controls. Thirteen studies were included in the quantitative meta-analysis.

Across 11 studies involving 1,007 participants, patients with PCOS had thicker average peripapillary retinal nerve fiber layer (RNFL) measurements than controls, with a pooled increase of about 4 µm. Heterogeneity across these studies was low, and the overall certainty of evidence for this finding was rated moderate.

Nine studies assessing central macular thickness identified a modest but statistically significant reduction in patients with PCOS compared with controls, with a pooled decrease of about 3 µm. Investigators noted that the magnitude of this difference was small and that the finding was sensitive to the inclusion of non–peer-reviewed data in sensitivity analyses.

Subfoveal choroidal thickness was evaluated in six studies. Overall, pooled estimates suggested thicker choroidal measurements in patients with PCOS, with an average increase of about 58 µm compared with controls. However, heterogeneity across studies was substantial, and certainty of evidence for this outcome was rated very low. Subgroup analysis suggested that choroidal thickening was observed primarily in cohorts in which disease duration was not specified, whereas studies including newly diagnosed patients showed no statistically significant difference.

In contrast, retinal microvascular density measured by OCTA showed no consistent differences between groups. Across three studies evaluating vessel density in the superficial capillary plexus and deep capillary plexus, pooled estimates showed no statistically significant differences compared with controls.

Additional structural analyses identified localized retinal differences. Meta-analysis of ganglion cell complex thickness showed increased measurements in patients with PCOS, with thickening concentrated in the inferior sector. Quadrant-level analysis of RNFL thickness identified a modest increase in the nasal region but no statistically significant differences in superior, inferior, or temporal quadrants.

The included studies were conducted between 2013 and 2026 and were primarily cross-sectional or case-control designs. Most were conducted in Turkey, and participant mean ages ranged from approximately 22 to 36 years. Most studies diagnosed PCOS using the Rotterdam criteria, while one study applied NIH diagnostic criteria. Several studies enrolled newly diagnosed patients, whereas others included participants with longer-standing diagnoses.

Study quality was assessed using the Newcastle–Ottawa Scale, with most studies rated as good quality. Evidence certainty based on the GRADE framework was moderate for RNFL thickness and central macular thickness, low for microvascular density measures, and very low for choroidal thickness because of substantial heterogeneity.

Study Limitations

The investigators reported several limitations. Most included studies were conducted in a single geographic region, potentially limiting generalizability. Variability in OCT devices and imaging protocols may have contributed to measurement differences across studies. Reporting of body mass index and disease duration was inconsistent, and all included studies were observational, preventing causal inference.

The researchers concluded that structural retinal and choroidal alterations may occur in patients with PCOS even when retinal microvascular density remains unchanged, suggesting that structural remodeling may occur in the absence of measurable microvascular density changes.

“Overall, the present systematic review and meta-analysis indicates evidence of retinal and choroidal structural changes linked to PCOS,” the researchers wrote.

The researchers reported no financial support and no conflicts of interest.

Source: Cureus