Psychiatric Comorbidities In Children With Keratoconus

To evaluate the association of keratoconus with psychiatric comorbidities in children.

Keratoconus is less common in the paediatric population compared to adults. It may significantly impact psychosocial development during adolescence, an important stage for emotional and cognitive growth. Studies have shown that keratoconus in adults is linked to psychological conditions such as anxiety, depression, ADHD, and OCD. However, little is known about this relationship in children.

The study aimed to assess the prevalence of psychiatric symptoms in children and adolescents with keratoconus and to examine the relationship between disease severity, psychosocial morbidity, and quality of life. It was conducted at the Hospital for Sick Children in Toronto, Canada. Baseline demographic data were collected to ensure comparability between the study and control groups. We assessed psychosocial functioning and health-related quality of life using validated questionnaires in pediatric patients with keratoconus. This was compared to a control group with high myopia or astigmatism. The two questionnaires used were the PSC-17 (Pediatric Symptom Checklist-17) and the PedsQL (Pediatric Quality of Life Inventory).

A total of 51 participants were recruited, comprising 30 patients diagnosed with keratoconus and 21 age-matched healthy controls who wore glasses. The PSC-17 assessed internalizing, externalizing, attention, and total scores, each reflecting a predisposition to specific psychiatric comorbidities. Among patients with keratoconus, 23% demonstrated abnormal overall scores and 17% had abnormal internalizing scores. The corresponding p-values for abnormal scores were 0.033 for the total score, 0.123 for internalizing symptoms, 0.075 for externalizing symptoms, and 0.105 for attention problems. On the PedsQL, keratoconus was associated with a measurable decline in school functioning and overall quality of life among affected children. 

This study explored the psychosocial and quality-of-life outcomes in children and adolescents with KC. Our findings indicate that overall quality of life and school functioning were significantly affected. These children also demonstrated elevated scores on the internalizing and attention subscales, suggesting a predisposition to anxiety, ADHD, and potentially disruptive or conduct disorders. These findings align with adult studies showing that individuals with keratoconus experience higher rates of anxiety and depression. However, unlike adult populations, our cohort of pediatric KC patients did not exhibit significant differences in externalizing behavior, suggesting that the psychosocial burden in children may manifest differently.