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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
When eye disease affects the mind: Psychological burden and functioning in autoimmune ophthalmology
Matteo Capobianco, Marco Zeppieri, Simonetta Gaia Nicolosi, Giuseppe Daniele Faro, Daniele Salanitro, Marieme Khouyyi, Fabiana D’Esposito, Caterina Gagliano
Matteo Capobianco, Giuseppe Daniele Faro, Eye Clinic, Policlinico G Rodolico, University of Catania, Catania 95121, Italy
Matteo Capobianco, Simonetta Gaia Nicolosi, Daniele Salanitro, 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
Marieme Khouyyi, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina 98121, Italy
Fabiana D’Esposito, Imperial College Ophthalmic Research Group Unit, Imperial College, London NW1 5QH, United Kingdom
Fabiana D’Esposito, Caterina Gagliano, Department of Medicine and Surgery, University of Enna “Kore”, Enna 94100, Italy
Caterina Gagliano, Mediterranean Foundation, “GB Morgagni”, Catania 95125, Italy
Co-first authors: Matteo Capobianco and Marco Zeppieri.
Author contributions: Zeppieri M, Capobianco M, Nicolosi SG, D’Esposito F, and Gagliano C did the research and writing of the manuscript; Zeppieri M, Capobianco M, Nicolosi SG, D’Esposito F, and Gagliano C assisted in the writing of the draft and final paper; Zeppieri M, Capobianco M, and Gagliano C were responsible for the study’s conception and design; Zeppieri M, Capobianco M, Nicolosi SG, D’Esposito F, Gagliano C, Faro GD, Salanitro D, and Khouyyi M assisted in the writing and editing of the manuscript; Zeppieri M assisted with editing, making critical revisions to the manuscript, and reviewing all versions; Zeppieri M participated equally and shares first authorship; all authors provided the final approval of the article.
Institutional review board statement: The Institutional Review Board and the Ethics Committee at our hospital in Catania granted an exemption for this observational, noninvasive, and retrospective study, based on routine, common clinical procedures. This was an observational study that collected data from a non-invasive, noncontact diagnostic exam commonly performed on most patients. As with most noncontact examinations, consent is not required to perform these tests in a routine clinical setting. This study was conducted in accordance with the ethical standards of our Institutional Review Board and with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent statement: All study participants provided informed written consent prior to study enrollment and for publication of data in scientific studies.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the first author (
capobiancoteo@gmail.com).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Marco Zeppieri, BSc, MD, PhD, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria della Misericordia 15, Udine 33100, Italy.
mark.zeppieri@asufc.sanita.fvg.it
Received: December 15, 2025
Revised: January 1, 2026
Accepted: January 16, 2026
Published online: February 6, 2026
Processing time: 54 Days and 9.2 Hours
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.
Core Tip: Patients living with rare and autoimmune eye diseases frequently face chronic pain, fear of blindness, diagnostic uncertainty, and disruption of social and work roles. In this pilot psycho-ophthalmology case series from an integrated ophthalmology-psychology clinic, about half of the patients showed clinically relevant anxiety, and many reported markedly impaired physical and, to a lesser extent, mental quality of life, despite the small sample size. Systematic use of brief standardized instruments (Hospital Anxiety and Depression Scale and 12-item Short Form Health Survey), combined with a focused clinical interview, proved feasible in routine care and directly informed decisions about psychological or psychiatric referral. Embedding mental health assessment within ophthalmology services may help clinicians identify vulnerable patients earlier, address emotional distress and maladaptive coping, and ultimately support better adaptation to chronic visual disease and complex immunomodulatory treatments.
