A study recently published in the American Journal of Ophthalmology evaluated the association between corneal dystrophy and mental health outcomes in patients with depression and anxiety disorders.
Give me some background.
Corneal dystrophies are a collection of hereditary ocular diseases characterized by progressive abnormal deposition of substances in the cornea, leading to visual impairment and episodic pain.
The progressive vision loss and chronic pain caused by corneal dystrophies can disrupt daily activities, diminish quality of life, and are known to exacerbate emotional distress.
However: Despite the established connections between mental health and other ocular conditions, no study has specifically explored the psychological burden associated with corneal dystrophies.
Now talk about the study.
In this propensity-score-matched cross-sectional study, investigators utilized electronic health record (EHR) data from the All of Us Research Program (AoURP).
- Note: The AoURP is a nationwide study sponsored by the National Institutes of Health to advance population health by seeking diverse recruitment of participants underrepresented in biomedical research.
The participants: Adults aged 18+ from the AoURP database with corneal dystrophy and no prior surgical treatment were matched 1:1 to controls based on demographic and comorbidities.
Further: Subgroup and interaction analyses were performed based on race, gender, and income.
And what was measured?
The main outcome measures included prevalence of depression and anxiety disorders.
Talk about the cohort.
Of the 371,398 participants with EHR data, 2,393 (0.6%) had corneal dystrophies without prior surgery, and these individuals were predominantly:
- Older (mean age 73.1 years, range: 25-90 years)
- Female (n = 1,482, 61.9%)
- White (n = 2,027, 84.7%)
In total, 10.5% (n = 252) of this cohort self-identified as Black or African American, 60.5% (n = 1,448) of participants reported attaining a college degree or higher, and 97.7% (n = 2,338) of participants had health insurance coverage.
- However: 13% (n = 310) of participants reported an annual income under $25,000.
Findings?
Individuals with corneal dystrophy had significantly higher prevalence of depression (32.0% vs. 13.7%) and anxiety (32.4% vs. 16.0%) compared to controls.
- Additionally: Increased odds of depression (odds ratio [OR]: 1.8, 95% confidence interval [CI]: 1.2-2.6) and anxiety disorders (OR: 2.5, 95% CI: 1.5-3.5) were observed.
Moreover: These associations remained significant across, race, gender, and income strata, with no significant effect modification by these factors.
Expert opinion?
“Given the observed association between corneal dystrophy and psychological distress, clinicians may consider incorporating brief mental health screening questions, such as the Patient Health Questionnaire-2 (PHQ-2) or Generalized Anxiety Disorder-2 (GAD2), in appropriate clinical contexts,” the study authors explained.
Limitations?
These included:
- The AoURP dataset does not contain detailed clinical or imaging data needed to confirm the exact subtype or severity of disease at the individual levelGiven the older age distribution of the cohort, it is likely that adult-onset endothelial dystrophies were predominant
- Given the older age distribution of the cohort, it is likely that adult-onset endothelial dystrophies were predominant
- However, the investigators were unable to reliably differentiate subtypes, which limited their ability to assess whether specific phenotypes confer differential psychological burden
Tie it all together.
These findings suggest that corneal dystrophy without prior surgical treatment is significantly associated with increased rates of depression and anxiety disorders.
Though demographic factors influence baseline mental health vulnerability, the psychological burden associated with untreated corneal dystrophy persists across populations.
- As such: It is critical to consider the psychological well-being of patients with corneal dystrophy—and integrating mental health awareness into ophthalmic care may benefit quality of life.
So what’s next for this area of research?
The study authors recommended that future studies examine coping mechanisms that influence patient resilience and provide more granular phenotyping to investigate whether distinct corneal dystrophies differ in their association with mental health outcomes, as such insights could inform more tailored psychosocial interventions.
Additionally, researchers could examine whether surgical treatment, especially modern endothelial keratoplasty, lessens the psychological burden seen in untreated patients.