Journal Highlights
JAMA Ophthalmology, December 2023
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The multifactorial pathophysiology of keratoconus involves genetic factors, enzymatic corneal degradation, and altered arrangement of collagen fibrils. Repetitive mechanical irritation of the cornea, which may occur from eye rubbing, raises the risk of keratoconus occurrence and progression. The cognitive and psychiatric factors that may contribute to self-rubbing of eyes have not been explored in depth, but there have been case reports and small studies of anxiety, autism, Tourette syndrome, obsessive-compulsive disorder (OCD), and other psychiatric conditions occurring in conjunction with keratoconus. In a population-based study, Safir et al. found that attention-deficit/hyperactivity disorder (ADHD) was significantly associated with keratoconus in univariate and multivariate analyses, whereas anxiety, OCD, and autism were not.
For this cross-sectional research, the authors reviewed medical records of Israeli adults and adolescents in military service from January 2011 through December 2021. The main outcome measures were rates of anxiety, OCD, autism, and ADHD among those with and without keratoconus. Univariate and multivariate analyses were used to determine the relationship between keratoconus and each psychiatric condition.
The study included 940,763 individuals; their mean age was 17.56 years, and 59.3% were male. Keratoconus was identified in 1,533 people (0.16%). Relative to the overall study population, ADHD was more common in the keratoconus cohort (odds ratio [OR], 1.58; p < .001), regardless of the severity of keratoconus. After adjustment for age, sex, height, weight, and intellectual status, the results did not change (hazard ratio, 1.46; p < .001). Stratification by age revealed a link between keratoconus and ADHD among males (OR, 1.62; p < .001) but not females (OR, 1.29; p = .09).
“These findings support further investigation into the potential value of education regarding eye rubbing in this population,” said the authors, who emphasized that further assessment of the risk factors for keratoconus could generate hypotheses to test in future interventional trials. Prospective studies would be needed to explore the possibility of a causative relationship between keratoconus and ADHD. (Also see related commentary by Maria A. Woodward, MD, MSc, and Emily L. Vogt, BA, in the same issue.)
The original article can be found here.