Keratoconus patients can develop a specific neurotic temperament, and practitioners should question them about their mental and emotional well-being.

Keratoconus patients can develop a specific neurotic temperament, and practitioners should question them about their mental and emotional well-being. Photo: Irving Martínez Navé, OD. Click image to enlarge.

Ever since publication of the Collaborative Longitudinal Evaluation of Keratoconus study back in 2004, it’s been known that many of these patients struggle to cope with the condition and develop personalities marked by its impact. In a new study, researchers aimed to describe the personality traits of patients affected by keratoconus compared with a group of non-keratoconic controls matched in age and sex. The study, published in Cornea, found that patients with this condition have a specific neurotic temperament and are at a higher risk for what’s known in the psychiatric literature as dysfunctional cluster C personality disorder—a mindset characterized by anxious, fearful thinking or behavior.

A total of 60 participants (30 keratoconus cases and 30 controls) aged 18 to 30 completed an ophthalmic evaluation and responded to the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), and also completed a psychiatric assessment.

The keratoconus cases had lower quality of life than controls, and nine patients with the condition were diagnosed with at least one cluster C personality disorder, resulting in a nine-fold increased risk compared with controls. Additionally, keratoconic patients showed a more pronounced psychosomatic symptomatology and a characteristic neurotic temperament.

Several observations might explain the occurrence of dysfunctional personality traits in this condition. “For instance, the onset of keratoconus typically occurs at a young age (e.g., young adults between the ages of 12 and 30), during one of the most important phases of the individual’s psychosocial and occupational development,” the authors explained. “The associated visual difficulties, the awareness of being affected by a disorder requiring periodic medical visits and the need to undergo both noninvasive and invasive treatments (e.g., use of spectacles or contact lenses, crosslinking and keratoplasty) are some of the elements which may act as a trigger for the development of dysfunctional personality traits and pathological coping mechanisms.”

In addition, results from psychiatric questionnaires indicated that keratoconic patients experience significant overall psychological distress.

“A neurotic temperament profile of patients with keratoconus clearly emerged where somatization, obsessive-compulsive, psychoticism traits and marked interpersonal sensitivity constitute the core of the psychosomatic symptomatology,” the authors explained in their paper. A previous study corroborates this study’s findings with neuroticism temperament and depressive, cyclothymic and irritable subscales.

It’s suggested that clinicians question patients with keratoconus about their mental and emotional status, which could result in early detection of those patients needing specific psychiatric consultation and psychological support.

Aiello F, Afflitto GG, Ceccarelli F, et al. Keratoconus and personality traits: a case-control study. Cornea. April 5, 2023. [Epub ahead of print].