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. 2023 Dec 1;141(12):1145-1150.
doi: 10.1001/jamaophthalmol.2023.5176.

Psychiatric Comorbidities Associated With Keratoconus

Margarita Safir  1   2   3 , Idan Hecht  1   2 , Dan Heller  3   4 , Eran Pras  1   2 , Michal Lifshitz  3   4 , Adi Einan-Lifshitz  1   2
Affiliations

Psychiatric Comorbidities Associated With Keratoconus

Margarita Safir et al. JAMA Ophthalmol. .

Abstract

Importance: Evaluating risk factors for keratoconus, often associated with recurrent eye rubbing, could generate hypotheses to be tested in future interventional trials.

Objective: To assess the risk for keratoconus associated with psychiatric comorbidities in adolescents and adults.

Design, setting, and participants: This population-based cross-sectional study included medical records of Israeli adolescents and adults in military service from January 2011 through December 2021.

Main outcomes and measures: The prevalence of anxiety, obsessive compulsive disorder (OCD), autism, and attention-deficit/hyperactivity disorder (ADHD) was evaluated in individuals with and without keratoconus. The association between keratoconus and psychiatric comorbidities was tested using univariate and multivariant analyses.

Results: Overall, 940 763 adolescents and adults were included. Mean (SD) age was 17.56 (1.47) years, and 59.3% were male. Keratoconus was documented in 1533 individuals, with a prevalence of 0.16%. Patients with keratoconus were more likely to be diagnosed with ADHD compared with the general population (odds ratio [OR], 1.58; 95% CI, 1.38-1.81; P < .001). After adjusting for age, sex, intellectual status, height, and weight, the results remained unchanged (hazard ratio, 1.46; 95% CI, 1.27-1.67; P < .001). Stratification according to age showed an association between keratoconus and ADHD for males (OR, 1.62; 95% CI, 1.39-1.90; P < .001) but not for females (OR, 1.29; 95% CI, 0.96-1.74; P = .09).

Conclusions and relevance: In a large cohort of adolescents and adults, ADHD was associated with a diagnosis of keratoconus in male patients, even after adjusting for possible confounders. Although a causative effect could not be ascribed, these findings support further investigation into the potential value of education regarding eye rubbing in this population.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Odds of Patients With Psychiatric Comorbidities Being Diagnosed With Keratoconus Compared With the General Population
ADHD indicates attention-deficit/hyperactivity disorder; OCD, obsessive compulsive disorder.
See this image and copyright information in PMC

Comment in

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