Keratoconus Affects Mental Health, Emotional Quality of Life Outcomes

Patients with keratoconus may potentially benefit from routine mental health screening.

Keratoconus affects mental health and quality of life (QOL) outcomes, according to a literature review published in Cornea. While further studies are needed to support this conclusion, the report suggests that individuals with this corneal ectasia may benefit from routine mental health screenings. 

Researchers included 31 articles exploring associations between keratoconus and mental health in a systematic review — 10 directly examined these correlations through questionnaires or registry-based data and 21 assessed emotional QOL domains. Among these investigations, 7 explored mental health outcomes following interventions such as rigid gas permeable contact lenses, scleral lenses, penetrating keratoplasty, or corneal crosslinking. The reports included cross-sectional investigations (n=15), case control studies (n=11), cohort studies (n=4), and a case series (n=1). 

[P]atients with keratoconus may still suffer detriments to their mental health despite having relatively good VA.

Among the 10 investigations directly investigating mental health outcomes, 5 revealed a positive correlation between keratoconus and mental health outcomes, 4 showed no correlation, and 1 revealed a negative correlation. The study authors note that the reports that failed to establish a correlation between mental health outcomes and keratoconus consisted of a heterogeneous population of individuals of Asian ethnicity and speculate that a negative perception of psychiatric disorders may have contributed to participants underreporting depressive symptoms. 

Assessment of the studies detailing emotional QOL domains showed that disease severity affected mental health scores. Participants with progressive disease had lower mental health scores compared with individuals with stable disease. Lower mental health scores were associated with worse visual acuity, ocular asymmetry, and disease severity, according to the report.  

A comparison with other ocular diseases revealed worse QOL and emotional well-being scores among individuals with keratoconus compared with patients with age-related macular degeneration (AMD), diabetic macular edema, and retinal vein occlusion, despite better mean visual acuity noted among participants with keratoconus. 

“Key messages that should be taken away include that patients with keratoconus may still suffer detriments to their mental health despite having relatively good [visual acuity] and that understanding and acceptance of their disease may be of great assistance in assuaging mental health concerns,” according to the study authors. 

Study limitations include a lack of consistency in questionnaires used to determine how keratoconus affects mental health and a failure to include a control group in many of the investigations.


Durakovic E, Kandel H, Watson SL. Mental health impact of keratoconus: a systematic review. Cornea. Published online May 13, 2023. doi:10.1097/ICO.0000000000003263