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The link between keratoconus and depression

Originally published in NKCF Update (December 2021).

In the past year, two international studies concluded that individuals with keratoconus suffer from depression and anxiety at a rate higher than the general public.

Doctors at the King Faisal University offered an on-line survey to individuals with keratoconus.  Participants were asked to complete a short health questionnaire (PHQ-9).  Of the 330 men and women living in Saudi Arabia who completed the survey, the prevalence of depression was estimated at 40.6% (n=134).  Most in this group (n=117, 82%) were classified as having moderate to severe depression.  

It is estimated that 17-25% of the population may show signs of a mental or behavioral disorder at some time.  The results of this study indicate a higher-than-expected link between KC and depression.  Since these surveys were anonymous, the authors were unable to make a connection between the severity of the keratoconus and mental health issues.  They did find a correlation between depression and contact lens wear and suggested “this may be attributed to the extra amount of effort required to cope with (contact lenses) and their impact on daily life activities . . . Additionally, in Saudi Arabia, the expenses of corrective contact lenses aren’t covered by the government or insurance companies which becomes a financial burden for patients with keratoconus.”

A second study was conducted by mental health and eyecare professionals in Istanbul, Turkey.  In this study, 94 men and women between the ages of 18 to 40 diagnosed with keratoconus completed two surveys assessing quality of life and depression.  They underwent a complete eye exam and participated in an interview at a psychiatric outpatient clinic.  This study found a significant link between KC and mental health outcomes.  Not surprisingly, they found more severe keratoconus had a greater impact on quality of life.  They determined that 33 (35%) of the participants suffered from moderate to severe depression or anxiety.  

The clinical concern that arises from these small studies is that depression and anxiety have been associated with poor compliance and adherence to treatment.  For KC patients, this can lead to vision loss and result in more depression or anxiety.  Generally, eye doctors do not ask their patients about their mental health, but if you believe you are experiencing emotional difficulties that could be related to keratoconus, tell your doctor who will help you find appropriate assistance.


Al-Dairi W, Sowayigh OM, Al Saeed A, et al, Depression Among Keratoconus Patients in Saudi Arabia, Cureus 12:e11932, 2021. 

Yildiz M, Turhan SA, Yargi B, et al, Psychiatric morbidity of patients with keratoconus: A cross-sectional study, J Psychosom Res 143:110364, 2021.