Ophthalmology Department, Shamir Medical Center, Zerifin, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
JAMA Ophthalmol. 2023 Dec 1;141(12):1145-1150. doi: 10.1001/jamaophthalmol.2023.5176.
Evaluating risk factors for keratoconus, often associated with recurrent eye rubbing, could generate hypotheses to be tested in future interventional trials.
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.
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.
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).
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.
评估圆锥角膜的风险因素，圆锥角膜常与反复眼揉有关，可能会产生假说，以便在未来的干预性试验中进行检验。
评估青少年和成年人中与精神共病相关的圆锥角膜风险。
设计、地点和参与者：这项基于人群的横断面研究纳入了 2011 年 1 月至 2021 年 12 月期间以色列服兵役的青少年和成年人的医疗记录。
评估有和无圆锥角膜的个体中焦虑症、强迫症 (OCD)、自闭症和注意缺陷/多动障碍 (ADHD) 的患病率。使用单变量和多变量分析来检验圆锥角膜与精神共病之间的关联。
共有 940763 名青少年和成年人被纳入研究。平均（SD）年龄为 17.56（1.47）岁，59.3%为男性。共记录了 1533 例圆锥角膜，患病率为 0.16%。与普通人群相比，患有圆锥角膜的患者更有可能被诊断为 ADHD（优势比[OR]，1.58；95%置信区间[CI]，1.38-1.81；P < .001）。在调整年龄、性别、智力状况、身高和体重后，结果保持不变（风险比[HR]，1.46；95% CI，1.27-1.67；P < .001）。根据年龄分层，圆锥角膜与 ADHD 之间的关联仅见于男性（OR，1.62；95% CI，1.39-1.90；P < .001），而女性中无此关联（OR，1.29；95% CI，0.96-1.74；P = .09）。
在一个大型青少年和成年人队列中，即使在调整了可能的混杂因素后，ADHD 与男性患者的圆锥角膜诊断仍相关。尽管不能归因于因果关系，但这些发现支持进一步研究在该人群中眼揉教育的潜在价值。
