Retinal imaging: A new tool for studying underlying liability to cardiovascular disease in schizophrenia

Despite evidence that individuals with schizophrenia are disproportionately affected by cardiovascular and cerebrovascular diseases, it is unclear if individuals with schizophrenia have an underlying liability to cardiovascular diseases or if these diseases are a consequence of psychotic illness (e.g., antipsychotic medications, sedentary lifestyle). To resolve this, we must study cardiovascular disease risk factors in individuals in the early stages of illness with limited exposure to antipsychotic medications (i.e., individuals with first-episode psychosis) and in unaffected relatives of individuals with schizophrenia. Here we review evidence of cardiovascular risk in individuals with first-episode psychosis and in unaffected relatives of individuals with schizophrenia. We identify a gap in research on cardiovascular risk in these populations, namely the lack of studies that directly visualize the vasculature, and we introduce a novel technology, retinal imaging, that may be useful for directly visualizing the vasculature and clarifying pathophysiological mechanisms that underlie both schizophrenia and cardiovascular disease. We conclude with suggestions for priorities in future research using retinal imaging.