Capobianco M, Zeppieri M. Letter to the Editor: Clarifying the scope of integrated psycho-ophthalmology: Reply to commentary on ‘When eye disease affects the mind’. World J Clin Cases 2026; 14(23): 124314 [DOI: 10.12998/wjcc.124314]
Corresponding Author of This Article
Marco Zeppieri, MD, PhD, Consultant, Postdoc, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria della Misericordia 15, Udine 33100, Italy. mark.zeppieri@asufc.sanita.fvg.it
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Ophthalmology
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letter
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Capobianco M, Zeppieri M. Letter to the Editor: Clarifying the scope of integrated psycho-ophthalmology: Reply to commentary on ‘When eye disease affects the mind’. World J Clin Cases 2026; 14(23): 124314 [DOI: 10.12998/wjcc.124314]
World J Clin Cases. Aug 16, 2026; 14(23): 124314 Published online Aug 16, 2026. doi: 10.12998/wjcc.124314
Letter to the Editor: Clarifying the scope of integrated psycho-ophthalmology: Reply to commentary on ‘When eye disease affects the mind’
Matteo Capobianco, Marco Zeppieri
Matteo Capobianco, Eye Clinic, Policlinico G. Rodolico, University of Catania, Catania 95121, Italy
Matteo Capobianco, Faculty of Medicine, University of Catania, Catania 95123, Italy
Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Marco Zeppieri, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34127, Italy
Author contributions: Capobianco M and Zeppieri M did the research and writing of the manuscript, prepared the draft and final paper, and were responsible for the conception and design of the study; Zeppieri M assisted in the editing, making critical revisions of the manuscript and viewing all versions of the manuscript. All authors provided the final approval of the article.
AI contribution statement: ChatGPT (OpenAI, GPT-5.3) and Grammarly were used to assist with summarizing existing literature, addressing issues in the rebuttal, and enhancing the flow and English language quality. No AI-generated images were used.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
Corresponding author: Marco Zeppieri, MD, PhD, Consultant, Postdoc, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria della Misericordia 15, Udine 33100, Italy. mark.zeppieri@asufc.sanita.fvg.it
Received: June 11, 2026 Revised: July 21, 2026 Accepted: July 28, 2026 Published online: August 16, 2026 Processing time: 62 Days and 9.7 Hours
Abstract
The author of this letter critically examines Nagamine’s judgement of our pilot case series published in the World Journal of Clinical Cases relative to cohort characterization, study design, and findings interpretation. The group had a mixed neurologic picture, but in general consisted mostly of patients referred for complex psycho ophthalmologic evaluation because of autoimmune or demyelinating neurologic comorbidities, which reflect real-life tertiary practice. As it is designed as a feasibility study, the study was not designed as a clinical efficacy trial, but as a descriptive case series and not as an intervention trial, and that the conclusion is belies as an intervention trial. The link between eye disease burden and mental distress is not one-way but a two-way and multi-faceted one. The “vision-identity-autonomy” conceptual framework refers to a model that can propel the development of multisectoral initiatives for health and wellbeing, as well as equity-oriented research. We recognize the necessity for a more rigorous prospective study but feel that the clinical practicality of integrated care models for detection and management of psychological distress in complex ophthalmic populations merits consideration. The stimulation of dialogue enhances nomenclature, methodology and future suggested research. In this letter, we specifically mention that the clarification points are as per the original pilot case series, but the more general conceptual points are not per se supported by the pilot series, and must be seen as ‘exploratory’ and ‘hypothesis-generating’.
Core Tip: The intention of the commentary is to delineate the ambit and meaning of the earlier published psyche-ophthalmology case series. The initial case series was an exploratory project of minor availability, feasibility and useful application from the clinical therapeutic point of view of a promising active holistic approach. The study looked at reciprocal relationship between eye disease and psychological distress, use of screening tools like Hospital Anxiety and Depression Scale and the exploratory nature of “vision-identity-autonomy” triad. This case series calls for additional controlled studies.
