Eye Movement Abnormalities Can Distinguish First-Episode Schizophrenia, Chronic Schizophrenia, and Prodromal Patients From Healthy Controls

Background: This study attempts to replicate in a Chinese population an earlier UK report that eye movement abnormalities can accurately distinguish schizophrenia (SCZ) cases from healthy controls (HCs). It also seeks to determine whether first-episode SCZ differ from chronic SCZ and whether these eye movement abnormalities are enriched in psychosis risk syndrome (PRS).

Methods: The training set included 104 Chinese HC and 60 Chinese patients with SCZ, and the testing set included 20 SCZ patients and 20 HC from a UK cohort. An additional 16 individuals with PRS were also enrolled. Eye movements of all participants were recorded during free-viewing, smooth pursuit, and fixation stability tasks. Group differences in 55 performance measures were compared and a gradient-boosted decision tree model was built for predictive analyses.

Results: Extensive eye-movement abnormalities were observed in patients with SCZ on almost all eye-movement tests. On almost all individual variables, first-episode patients showed no statistically significant differences compared with chronic patients. The classification model was able to discriminate patients from controls with an area under the curve of 0.87; the model also classified 88% of PRS individuals as SCZ-like.

Conclusions: Our findings replicate and extend the UK results. The overall accuracy of the Chinese study is virtually identical to the UK findings. We conclude that eye-movement abnormalities appear early in the natural history of the disorder and can be considered as potential trait markers for SCZ diathesis.