Psychology of Keratoconus

Keratoconus can fundamentally alter the psychosocial profile of an individual, given its adolescent onset and high disease burden. Among the medical community, the concept of a keratoconic personality characterized by anxiety, insecurity, and distrust is widespread. However, review of the literature reveals mixed evidence about the psychiatric traits of keratoconic patients and fails to clarify a personality profile specific to keratoconus. Rather, patients with keratoconus likely experience significant impact on their quality of life during their formative adolescent years, even in the presence of good corrected visual acuity. As a result, patients may develop and display maladaptive coping mechanisms, especially in interfacing with healthcare systems, leaving providers with the impression of a “keratoconic personality.” A dissonance between the patient and provider assessment of disease burden can further interfere with a healthy patient-provider relationship and subsequent care patterns. Keratoconus is also associated with other mental health disorders such as depression. Providers must consider the significant psychological impact of keratoconus when caring for these patients.