Visual dysfunction and psychosis: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis examined links between visual dysfunction and psychosis-related outcomes across 56 studies, including longitudinal, genetically informed, case-control, cross-sectional, and case-report evidence. Findings varied by visual domain and study design; cross-sectional studies showed the most consistent association. In the primary meta-analysis of 12 cross-sectional estimates, visual impairment was associated with higher odds of psychosis-related outcomes (OR = 1.98, 95% CI 1.35-2.90). The authors interpret the evidence cautiously, favouring a bidirectional, domain-based framework over a single causal pathway from visual impairment to psychosis.

Key findings

• Across 12 cross-sectional estimates, visual impairment was associated with higher odds of psychosis-related outcomes (OR = 1.98, 95% CI 1.35-2.90).
• Sensitivity analyses remained positive after broader eligibility criteria and exclusion of the largest effect estimate.
• Case-control studies reported abnormalities across multiple visual domains, while findings for visual acuity were mixed.
• Longitudinal findings were heterogeneous, including positive, inverse, null, attenuated, and reverse-direction associations.

Why it matters

The findings suggest that visual dysfunction may be relevant to psychosis-related outcomes, but the association is not uniform across visual domains or study designs. Distinguishing clinically defined impairment from visual-processing, oculomotor, and higher-order abnormalities may help frame research and assessment more precisely. The mixed longitudinal evidence cautions against assuming that visual impairment alone causes psychosis.

What to keep in mind

The evidence was heterogeneous, and the primary meta-analysis used cross-sectional estimates, which cannot establish temporal direction or causality. Smaller subgroup analyses were less precise.