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SAN FRANCISCO — Delayed ophthalmic care may contribute to an increased risk for certain types of psychosis.

In analysis of nearly 121,000 older patients with glaucoma, those who received delayed eye care had significantly greater risk for the development of brief psychotic disorder, delusional disorder, or schizoaffective disorder within 5 years compared to those who received timely eye care. 

Assessment of 44,000 additional patients with diabetic retinopathy showed similar outcome risks for delayed vs timely care. For both eye conditions, there were no associations with increased risk for developing schizophrenia. 

Overall, the findings highlight the importance of early treatment after an ocular disease diagnosis, said co-investigator Jason Guo, medical student at the David Geffen School of Medicine, University of California-Los Angeles (UCLA). 

“It’s important that we catch things early on so we can prevent other health issues,” Guo told Medscape Medical News. 

He presented the results May 18 at the American Psychiatric Association (APA) 2026 Annual Meeting. 

The Eyes Have It

Previous research assessing associations between ocular diseases and psychiatric conditions have typically focused more on depression and anxiety than on psychosis, Guo noted, with even fewer studies evaluating the effect that delayed eye care might wield. 

He added that a potential hypothesis for the association between progressive vision loss and psychosis development involves sensory deprivation, functional impairment, and social isolation.

“When you don’t have that visual input, you could have an altered perception, which could lead to functional impairment and withdrawal — all of which are associated with psychiatric comorbidities,” Guo said. 

The current retrospective cohort study included 2005-2025 data from the TriNetX electronic health records for patients at least 50 years of age with a diagnosis of either glaucoma (n = 120,917; mean age, 69 years; 59% women) or diabetic retinopathy (n = 44,058; mean age, 64 years; 52% women). Participants within each subgroup were matched by age, sex, and race. 

Patients were considered to have received “timely treatment” if they had an ophthalmology visit or treatment within 6 months of diagnosis. No ophthalmology visits or procedural treatments within 1 year of diagnosis was considered to be “delayed treatment.”

Results from the glaucoma-group analysis showed that, compared with participants with timely care, those who received delayed care had an increased risk for brief psychotic disorder (risk ratio [RR], 1.4; P = .02), delusional disorder (RR, 1.5; P = .001), and schizoaffective disorder (RR, 1.4; P = .003). 

For those with diabetic retinopathy, the risks for delayed vs timely care were also increased for brief psychotic disorder (RR, 2.4; P < .001), delusional disorder (RR, 1.3; P < .01), and schizoaffective disorder (RR, 1.7; P < .001). 

Neither glaucoma nor diabetic retinopathy was associated with a significant risk for schizophrenia. Although he said he was a bit surprised with this finding, Guo noted that it could have been due to the older age of the participants and that schizophrenia development often occurs in young adults.

He added that future studies are now needed to assess the dose-response relationships between duration of delayed treatment and subsequent psychosis risk, as well as reasons why some patients receive delayed care while others do not.

Growing Interest

Paulo Lizano, MD, PhD, associate professor of psychiatry and director of the Early Psychosis Research Program at the University of Rochester Medical Center, Rochester, New York, applauded both the study and the use of the large dataset, which he said allowed for “quicker insights” into the investigated outcomes. 

Although not involved with the current research, Lizano has been part of other studies that have assessed how vision problems may be associated with psychiatric conditions — and is a steering committee member of the Consortium for Vision and Oculomics in Psychiatry (CVOP).

“About 6 or 7 years ago, there were very few studies that were looking at vision, particularly early vision, and how the retina detects changes that are happening that might be related to psychosis; but we’ve come a long way in a short amount of time,” Lizano told Medscape Medical News. 

“There’s a growing interest in this area and I was excited about this [new] study,” he added. 

Lizano agreed with the investigators that the older age of the study population could be a plausible reason for not finding an association between ocular problems and the development of schizophrenia itself. 

He added that he would have liked to have seen these issues also explored in younger groups, including pediatric patients. That said, later-age psychosis can develop, he noted. 

“If delayed ophthalmic care results in the development of even brief psychotic disorder or psychotic-like symptoms, being able to screen and address those problems earlier or having that be part of the differential early on can be helpful to try to avoid these kinds of situations that can be devasting later on,” Lizano said. 

The takeaway message for mental health providers, he noted, is the importance of considering the whole person during an assessment “and thinking outside of the box” from what they usually look at, including vision, hearing, pain, and other sensory issues. 

Database access was granted in collaboration with the University of California, Riverside. Guo and Lizano reported no relevant financial relationships.