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- Title
Psychiatric Comorbidities Associated With Keratoconus.
- Authors
Safir, Margarita; Hecht, Idan; Heller, Dan; Pras, Eran; Lifshitz, Michal; Einan-Lifshitz, Adi
- Abstract
This cross-sectional study assesses whether risk for keratoconus is higher in adolescents and adults with psychiatric comorbidities. Key Points: Question: Are various psychiatric comorbidities associated with keratoconus diagnosis? Findings: In this population-based cross-sectional study of 940 763 adolescents and adults who underwent systematic medical and ophthalmologic evaluation, attention-deficit/hyperactivity disorder was associated with a diagnosis of keratoconus in male patients on univariate and multivariate analysis. Meaning: These findings support further investigations into associations of keratoconus with various psychiatric comorbidities. 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.
- Publication
JAMA Ophthalmology, 2023, Vol 141, Issue 12, p1145
- ISSN
2168-6165
- Publication type
Article
- DOI
10.1001/jamaophthalmol.2023.5176