Investigating the Relationship Between Corneal Dystrophy and Mental Health Conditions Using the All of Us Research Program Database

Am J Ophthalmol. 2025 Aug 1:S0002-9394(25)00393-9. doi: 10.1016/j.ajo.2025.07.032. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the association between corneal dystrophy and mental health outcomes, specifically depression and anxiety disorders, in a large, socioeconomically diverse population.

DESIGN: Propensity score-matched cross-sectional study using electronic health record (EHR) data from the NIH’s All of Us Research Program (AoURP).

PARTICIPANTS: Adults aged 18 and older from the AoURP v8 database, including individuals with a diagnosis of corneal dystrophy and matched controls without the condition.

METHODS: Individuals with corneal dystrophy and no prior surgical treatment were matched 1:1 to controls based on demographics and comorbidities using nearest neighbor propensity score matching without replacement. Covariate balance was assessed using standardized mean difference, with value less than 0.10 considered indicative of good balance. Prevalence comparisons and odds ratios were calculated post-matching. Subgroup and interaction analyses were performed by race, gender, and income.

MAIN OUTCOME MEASURES: Prevalence of depression and anxiety disorders.

RESULTS: Among 371,398 participants with EHR data, 2,393 (0.6%) had corneal dystrophy without prior surgery; they were predominantly older (mean age 73.1), female (61.9%), and White (84.7%). Matched controls were well-balanced across covariates. Individuals with corneal dystrophy had significantly higher prevalence of depression (32.0% vs. 13.7%) and anxiety (32.4% vs. 16.0%) compared to controls (both p < 0.001), with increased odds of depression (OR = 1.8; 95% CI: 1.2-2.6) and anxiety disorders (OR = 2.5; 95% CI: 1.5-3.5). Associations remained significant across race, gender, and income strata, with no significant effect modification by these factors.

CONCLUSIONS: Corneal dystrophy without prior surgical treatment is significantly associated with increased rates of depression and anxiety disorders. While demographic factors influence baseline mental health vulnerability, the psychological burden associated with corneal dystrophy persists across populations. These findings highlight the need to consider the psychological well-being of patients with corneal dystrophy and suggest that integrating mental health awareness into ophthalmic care may benefit quality of life.

PMID:40754259 | DOI:10.1016/j.ajo.2025.07.032