Keratoconus Associated With Depression, Anxiety

In a cross-sectional study, researchers found that 35 of 94 participants with keratoconus experienced psychiatric morbidity.

A diagnosis of keratoconus may have a high association with psychiatric morbidity, depression, anxiety, and a low quality of life (QoL), according to findings published in the Journal of Psychosomatic Research. 

Researchers at the Marmara University departments of ophthalmology and psychiatry in Istanbul, Turkey conducted a cross-sectional study to find out the nature of psychiatric diagnosis, depression, anxiety, and QoL associated with keratoconus, a progressive disease of the cornea that causes visual impairment and asymmetric astigmatism.

The study included 94 participants with keratoconus who underwent ophthalmic and psychiatric examinations and completed The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) questionnaires. Participants were between the ages of 18 years and 40 years old. 

The researchers found that 37.2% (n=35) of participants had psychiatric diagnosis according to the Structured Clinical Interview for the DSM-IV Axis (SCID-1), 13.8% (n=13) had moderate-severe depression according to the BDI, and 21.2% (n=20) had moderate-severe anxiety, according to the BAI. There was also an association between more severe keratoconus and a high probability of having a psychiatric diagnosis. Participants also completed the Short Form-36 (SF-36), and results found that those with a psychiatric diagnosis scored lower on subscales of physical functioning; role limitations due to emotional problems, energy, and fatigue; emotional well-being; social functioning, and pain. However, the presence of a psychiatric disorder did not affect NEI-RQL-42 questionnaire scores significantly. 

The researchers explain that, because the mean age of keratoconus diagnosis is 28.3 years, it should be taken into consideration that the participants of this study were relatively young, with a mean age of approximately 23.9 years.

Also, they conclude that, although rates of psychiatric morbidity in chronic physical diseases vary greatly throughout the world, the results of the present study show that there is an association between keratoconus and increased psychiatric diagnosis.

“The prevalence of psychiatric disorders in the general population has been reported to be approximately 17.2% in Turkey,” the study explains. “Thus, the psychiatric morbidity of patients with keratoconus is much higher than that in the general population and is comparable to that of patients with other chronic physical diseases.”

Limitations of the study include its cross-sectional nature, lack of control group, and a male majority within the sample.


M. Yildiz, S.A. Turhan, B. Yargı, et al., Psychiatric morbidity of patients with keratoconus: A cross-sectional study. J Psychosom Res. Published online February 3, 2021. doi:10.1016/j.jpsychores.2021.110384