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  • Cornea/External Disease

    Review of: Keratoconus and personality traits: A case-control study

    Aiello F, Afflitto G, Ceccarelli F, et al. Cornea, February 2024

    A small study comparing the mental health of young adults with keratoconus to that of matched controls found that individuals with keratoconus appear to be disproportionately affected by anxious, depressed, or neurotic personality traits and tend to experience lower vision-related quality of life. If validated, these findings suggest that increased mental health support could be warranted for these individuals.

    Study Design

    The prospective, interventional case-control study included 30 patients with keratoconus and 30 age- and sex-matched controls; all patients were between 18 and 30 years of age. Patients were enrolled during their first visit at an ophthalmology department in Italy and subsequently responded to the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in addition to undergoing several psychiatric assessments.


    Patients with keratoconus reported lower vision-related quality of life scores in all subdomains of the NEI VFQ-25 questionnaire and had a 9-fold increased risk of cluster C personality disorders (those associated with anxious or fearful behaviors) in comparison to controls. Individuals with keratoconus also presented with higher depressive, cyclothymic, and irritable temperament scores and were more likely to demonstrate a neurotic temperament than patients without keratoconus.


    Limitations of this study include the case-control design, which did not evaluate changes in personality traits over time. Secondly, the findings of the investigation may not be applicable to older keratoconus patients or individuals from other geographic regions.

    Clinical Significance

    While there is no obvious causal relationship between keratoconus and personality or mental health traits, the findings from this study highlight how the management of patients with keratoconus is likely not limited to managing their ocular disease. Many patients experience psychological distress that could impact their quality of life. Hence, ophthalmologists should consider psychological status when evaluating patients with keratoconus, which may help identify those who could benefit from psychiatric support.

    Financial Disclosures: Dr. Zeba Syed discloses financial relationships with Bio-Tissue, Recordati Rare Diseases (Consultant/Advisor, Lecture Fees/Speakers Bureau); Dompe, Glaukos Corporation (Grant Support); Tarsus Pharmaceuticals (Lecture Fees/Speakers Bureau).