When eye disease affects the mind: Psychological burden and functioning in autoimmune ophthalmology

BACKGROUND: Autoimmune and rare ophthalmic diseases can affect not only vision but also patients' mental well-being and everyday functioning; however, psychological aspects remain under-assessed in routine eye care. AIM: To investigate a descriptive consecutive case series reporting 18 adults evaluated at a newly established integrated psycho-ophthalmology clinic in Catania, Italy, where ophthalmologists and psychologists jointly assessed patients with complex inflammatory, autoimmune, or degenerative ocular conditions. METHODS: All participants completed a semi-structured clinical psychological interview and brief standardized screening for anxiety/depressive symptoms and health-related quality of life [Hospital Anxiety and Depression Scale (HADS); 12-item Short Form Health Survey (SF-12)]. RESULTS: The cohort had a mean age of 54.2 ± 15.6 years (range 24-85), and most patients (17/18) had systemic autoimmune, rheumatologic, or demyelinating comorbidity; dry eye/ocular surface disease was present in 6/18 (33.3%). Clinically significant anxiety symptoms (HADS-anxiety ≥ 11) were observed in 9/18 patients (50.0%), while clinically significant depressive symptoms [HADS-depression (HADS-D) ≥ 11] were present in 3/18 (16.7%), with an additional 6/18 (33.3%) showing borderline depressive scores (HADS-D 8-10). Physical health-related quality of life was markedly reduced (mean SF-12 physical 35.8 ± 10.9), with 12/18 (66.7%) scoring < 40; mental quality of life was more heterogeneous (mean SF-12 mental 41.3 ± 12.3), with 8/18 (44.4%) scoring < 40. Findings were clinically actionable: Based on the integrated assessment (scores plus interview), structured psychological support or psychotherapy was recommended for 9/18 (50.0%) patients, and a more in-depth psychiatric/psychological evaluation for 2/18 (11.1%). CONCLUSION: This pilot series highlights the high psychological burden and functional impairment in autoimmune and rare ophthalmic populations and supports the feasibility and clinical utility of embedding brief mental health screening plus focused interview within routine ophthalmic care.