Keratoconus and Personality—A Review

Mannis, Mark J.; Ling, Jennifer; Kyrillos, Ralph; Barnett, Melissa

doi:10.1097/ico.0000000000001479

Cited by 29 publications

(43 citation statements)

References 14 publications

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“…7 Despite this, an important limitation of KORG is the fact that the mental sphere of patients is not taken into account for the measurement of their QoL. 4 The importance of the emotional component of patients with keratoconus was revealed by recent studies that have shown that patients with ectasia have different personality coping mechanisms, 9 and have a higher rate of depression. Given this aspect, it could be suggested that leaving aside the emotional sphere of patients could deprive the researcher and clinician of extremely important information to measure the true QoL of patients with keratoconus.…”

Section: Discussionmentioning

confidence: 99%

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<p>Development and Validation of the “Keratoconus End-Points Assessment Questionnaire” (KEPAQ), a Disease-Specific Instrument for Evaluating Subjective Emotional Distress and Visual Function Through Rasch Analysis</p>

Balparda¹,

Herrera-Chalarca

Silva-Quintero

et al. 2020

OPTH

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Background: Keratoconus is a disease characterized by progressive distortion of the corneal anatomy, coupled with a decrease in vision. Assessing quality of life (QoL) in keratoconus is essential. So far, no instrument in the world has been designed to evaluate both visual function and emotional distress in this population. The purpose of the following study is to develop and validate the "Keratoconus End-Points Assessment Questionnaire" (KEPAQ) in a population of ectatic patients, the very first disease-specific scale to measure emotional latent traits in keratoconus. Methods: A last generation, Rasch analysis method was used for scale validation. First, a number of focus groups were carried out to create a pool of potential items. Then, a series of processes (such as "Content Validity Index") was carried out to develop a prior, 20question version of the KEPAQ. Then, a study including 150 keratoconus patients was performed, followed by a careful Rasch analysis to validate and optimize both sub-scales (Emotional Compromise, KEPAQ-E, and Functional Compromise, KEPAQ-F). Results: Initially, 86 items were considered as potential elements. After test optimization, 20 items were retained. A total of 150 patients with a confirmed diagnosis of keratoconus were included for the Rasch analysis. The mean age was 29.84 ± 9.96 years. In 150 patients, 12.6% had a history of keratoplasty, 46.0% had corneal rings, and 31.3% had crosslinking. For both sub-scales, misfitting items were removed until no misfitting was determined by repetitive Rasch runs. For the final version of the KEPAQ-E sub-scale, variance explained by the model was 62.4% with a dimensional scale. Person Separation Index and Person Number of Strata were 2.43 and 3.57, respectively. For the final version of the KEPAQ-F sub-scale, variance explained by the model was 61.3% with a unidimensional scale. Person Separation Index and Person Number of Strata were 3.19 and 4.59, respectively. Both sub-scales showed excellent Person Reliability. Conclusion: The KEPAQ is a robust scale, developed and validated through the latest theoretical models. It shows excellent psychometric properties, which render it extremely useful for both clinical and research use. To date, the KEPAQ is the only disease-specific scale worldwide to evaluate both functional and emotional compromise in keratoconus patients.

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Section: Discussionmentioning

confidence: 99%

“…It has also been linked to particular different personality coping mechanisms. 9 Therefore, as has been highlighted before by Kandel et al, 4 it is of paramount importance that an instrument for the adequate measurement of the QoL in patients with keratoconus must necessarily include a component of the emotional sphere of the patients.…”

Section: Introductionmentioning

confidence: 97%

<p>Development and Validation of the “Keratoconus End-Points Assessment Questionnaire” (KEPAQ), a Disease-Specific Instrument for Evaluating Subjective Emotional Distress and Visual Function Through Rasch Analysis</p>

Balparda¹,

Herrera-Chalarca

Silva-Quintero

et al. 2020

OPTH

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“…There may be personality traits that can moderate or mediate the perception of eye and vision problems. 4. Both groups of problems may at least partially share common risk factors, etiology, and pathophysiology.…”

Section: Concluding Considerationsmentioning

confidence: 99%

“…Some of them are so striking that special psychiatric states have been discussed and hypothesized. The best example is keratoconus personality, which is still under debate and has not yet been confirmed and a separate entity (4).…”

Section: Introductionmentioning

confidence: 99%

Dry Eyes, Vision Problems, and Psychiatric Symptoms: Are We Missing Something?

Toth

2020

Soc psih

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Problemi vida i patologija oka često su u komorbiditetu s psihijatrijskim stanjima. Ovaj rad pruža pregled dostupnih istraživanja o takvim vezama i podiže osviješćenost o mogućem značenju i učincima različitih očnih simptoma i oštećenja vida na psihijatrijska stanja i psihičke simptome. Dodatno, psihološke karakteristike i psihijatrijska stanja razmatraju se kao mogući uzroci problema oka i vida. Većina istraživanja otkriva povezanost između problema oka i vida s psihijatrijskim stanjima i psihičkim smetnjama. Blaži oftalmološki problemi najčešće su povezani s poremećajima raspoloženja, a manje s ostalim psihijatrijskim stanjima. Ozbiljni oftalmološki problemi, poput gubitka oštrine vida, povećavaju rizik za reaktivnu depresiju. Manji broj istraživanja potvrđuje vezu između psihotičnih poremećaja i vida, koja uglavnom mijenja vidnu percepciju. Zaključno, razmotrene su moguće interakcije i odnosi između psihijatrijskih stanja i problema oka i vida te preporuke za buduća istraživanja. U preporukama za usmjeravanje i zbrinjavanje pacijenata naglašen je holistički pristup u tretmanu pacijenata. / Vision problems and eye pathology are often comorbid with psychiatric conditions. This paper provides a review of available studies about these associations and raises awareness on possible causes and impacts of different eye symptoms and vision impairment on psychiatric states and psychological symptoms. Additionally, psychological characteristics and psychiatric conditions are considered as a possible cause of eye and vision-related problems. Most of the studies found an association of eye and vision problems with psychiatric conditions and psychological disturbances. Ophthalmic problems of a milder nature are mostly associated with mood disorders and less commonly with other psychiatric conditions. Serious eye conditions, like a loss of visual acuity, increase the risk for reactive depression. Fewer studies presented a connection between psychotic disorders and vision, which mostly alters visual perception. In the concluding section, possible interactions and relationships between psychiatric conditions and eye and vision problems are presented, along with recommendations for future research. The importance of holistic professional care in patient treatment is particularly emphasized in the recommendations for patient management.

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“… 2 KCN has a profound impact on the subjective quality of vision and life, especially in psychological aspects that might be overlooked by health-care providers. 3 Corneal collagen cross-linking (CXL) as a treatment that focuses on the underlying pathophysiology of the disease uses a combination of riboflavin (Vitamin B2) and ultraviolet-A (UV-A) light to strengthen the corneal tissue through photosensitization and chemical cross-linking. 4 5 Postoperative pain and complications resulting from epithelial debridement in the standard CXL procedure led to CXL without epithelial removal, known as transepithelial CXL.…”

Section: Introductionmentioning

confidence: 99%

Corneal collagen cross-linking using epithelium disruptor instrument in progressive keratoconus

et al. 2020

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Purpose: To compare the effects of accelerated corneal collagen cross-linking (CXL) in progressive keratoconus (KCN) patients via epithelium removal and transepithelial techniques, using Daya Disruptor (Duckworth and Kent, Hertfordshire, UK). Methods: This study is a double-blinded, randomized clinical trial. Patients with documented bilateral progressive KCN were randomized into two groups: one eye underwent epithelium removal (Group 1), and the fellow eye underwent epithelium disruption (Group 2). The primary outcomes were best corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA), Scheimpflug-extracted keratometric indices, and anterior segment-optical coherence tomography-derived epithelial thickness profiles. These parameters were evaluated before and 12 months after CXL. Results: Sixty-four eyes from 34 patients with progressive KCN (34 eyes in the epithelium-removal group and 30 eyes in the epithelium-disruption group) were included. The mean ± standard deviation (SD) of age was 23.4 ± 3.8 years in the epithelium-removal group and 23.2 ± 3.5 years in the epithelium-disruption group. The mean ± SD of the preoperative spherical equivalent (SE), front maximum keratometry (K-max), back K-max, thickness of thinnest point, and corneal apex thickness were − 2.9 ± 3.0 diopter (D) and − 3.7 ± 3.1 D ( P = 0.183), 53.8 ± 5.15 D and 54.4 ± 5.53 D ( P = 0.653), −6.63 ± 2.40 D and − 6.68 ± 2.48 D ( P = 0.131), 459.2 ± 37.4 μm and 460.8 ± 32.7 μm ( P = 0.708), 470.5 ± 37.7 μm and 469.7 ± 33.1 μm ( P = 0.679), and 55.4 ± 4.97 μm and 54.6 ± 7.16 μm ( P = 0.767) in the epithelium-removal and epithelium-disruption groups, respectively. The mean ± SD changes of the UCVA and BCVA 12 months after CXL were − 0.1 ± 0.11 and − 0.02 ± 0.18 and − 0.04 ± 0.12 and − 0.02 ± 0.14 in the epithelium-removal and epithelium-disruption groups, respectively. No statistically significant improvement was observed in the UCVA and BCVA between the two groups ( P = 0.868 and P = 0.937, respectively). The mean ± SD changes of the SE, superior epithelial thickness, corneal apex thickness, and thickness of thinnest point 12 months after CXL were − 0.21 ± 1.1 D and + 0.32 ± 1.6 D ( P = 0.0001), −0.08 ± 0.26 μm and + 0.03 ± 0.33 μm ( P = 0.028), −23 ± 11 μm and − 2 ± 6 μm ( P = 0.0001), and − 25 ± 8 μm and − 3 ± 7 μm ( P = 0.0001) in the epithelium-removal and epithelium-disruption groups, respectively. Conclusions: This study showed that the epithelium-disruption CXL using Daya has a similar potential for halting KCN progression as the epithelium-removal CXL. However, regarding the 12-month changes, the epithelium-di...

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Keratoconus and Personality—A Review

Abstract: We hypothesize that the stage of life at which keratoconus commonly presents plays a crucial role in personality and coping mechanism development that significantly affects behavioral patterns and the relationship with caregivers.

Cited by 29 publications

References 14 publications

<p>Development and Validation of the “Keratoconus End-Points Assessment Questionnaire” (KEPAQ), a Disease-Specific Instrument for Evaluating Subjective Emotional Distress and Visual Function Through Rasch Analysis</p>

<p>Development and Validation of the “Keratoconus End-Points Assessment Questionnaire” (KEPAQ), a Disease-Specific Instrument for Evaluating Subjective Emotional Distress and Visual Function Through Rasch Analysis</p>

Dry Eyes, Vision Problems, and Psychiatric Symptoms: Are We Missing Something?

Corneal collagen cross-linking using epithelium disruptor instrument in progressive keratoconus

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