Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder associated with systemic metabolic and hormonal imbalances that may impact microvascular health. This study aimed to investigate retinal and choroidal alterations in women with PCOS using optical coherence tomography (OCT) and OCT angiography (OCT-A). We conducted a cross-sectional analysis including three independent cohorts comparing women diagnosed with PCOS to matched healthy controls. Retinal parameters assessed included superficial and deep capillary plexus vessel densities, foveal retinal thickness, retinal nerve fiber layer (RNFL) thickness, and subfoveal choroidal thickness (CT), alongside metabolic and hormonal profiling. Results showed a significant reduction in superficial parafoveal vessel density in PCOS patients, increased subfoveal CT, and phenotype-specific increases in superior RNFL thickness, particularly in women with obesity and hyperandrogenism. These findings suggest early microvascular compromise and hormonal modulation of ocular structures in PCOS. The study highlights the potential of OCT and OCT-A as noninvasive biomarkers for systemic vascular and endocrine dysfunction in PCOS. Further prospective, phenotype-stratified studies with standardized imaging and longitudinal follow-up are warranted to confirm these associations and assess therapeutic impacts. Overall, retinal and choroidal imaging may provide valuable insight into the systemic manifestations of PCOS and guide personalized clinical management.