What is the association between higher refractive errors and the development of mental health disorders?
September 8, 2026
By Janelle Scully
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Using data from the U.K. Biobank, Sun and colleagues have conducted the first large-scale investigation of the relationship between refractive error and mental health.
The primary outcome was the diagnosis of mental health disorders, including depression, bipolar disorder and schizophrenia. Individuals with refractive error had significantly higher incidence of mental health disorders than emmetropes, with similar (and slightly greater) associations observed for individuals with hyperopia and hyperopia with astigmatism. While myopes initially showed a decreased risk compared to emmetropes, this association did not persist after adjusting for potential confounders. Participants with corrected visual acuity worse than 20/20 had significantly higher risk of mental health disorders than those who achieved 20/20 vision or better.
Responses to a mental health questionnaire were available for a subgroup of participants. Individuals with refractive error reported significantly lower subjective well-being and life satisfaction, alongside higher scores for neuroticism, anxiety and depressive symptoms compared with emmetropes.
This study benefits from a large sample size and long-term follow-up. However, the cohort is limited to middle-aged U.K. residents (40-69 years), and a clear causative link between refractive error and mental health disorders remains elusive. Further research is warranted to better understand the potential relationship between refractive error and mental health.
Abstract
Associations Between Refractive Errors and Mental Health: A Cohort Study of U.K. Biobank Participants
Bingqing Sun, Yuwei Peng, Ruilang Lin, Xiaojun Hu, Ruoyan Wei, Yongfu Yu, Xingtao Zhou, Meiyan Li, Weiming Yang
Background
Although vision impairment has been shown to negatively impact the quality of daily life, no large-scale studies have reported the effect of refractive errors (REs) on mental health. Therefore, this study aimed to investigate the influence of different types and severities of REs on mental health disorders.
Methods
UK Biobank participants who underwent ophthalmologic examinations were analyzed in this population-based cohort study. A Cox proportional hazards regression model was established using REs as exposure factors to determine the associations between REs and the risk of mental health disorders. A multiple linear regression model was used to explore the relationships between REs and the outcomes of a 12-item mental health questionnaire. The primary and secondary outcomes were risk of mental health disorders and the 12-item mental health questionnaire results, respectively.
Results
A cohort of 106,004 participants, initially free of mental disorders, was followed up for a median duration of 12.5 years, during which 15,608 (14.72 %) were diagnosed with mental health disorders. Participants with REs have a significantly higher risk of mental health disorders than those with emmetropia (hazard ratio [HR]: 1.07, 95 % CI: 1.01-1.13). Individuals with astigmatism (HR: 1.13, 95 % CI: 1.02-1.25), hyperopia (HR: 1.20, 95 % CI: 1.12-1.28), and hyperopia with astigmatism (HR: 1.28, 95 % CI: 1.13-1.44) had a higher risk of mental health disorders than those with emmetropia. The dose-response curve indicated that the risk of mental health disorders increased as corrected visual acuity decreased.
Participants with REs had significantly lower life satisfaction and subjective well-being (both P < 0.01) and higher scores for neuroticism, depressive symptoms, and anxiety symptoms (all P < 0.01) than those with emmetropia, particularly among individuals with hyperopia and astigmatism (neuroticism: β = 1.16, 95 % CI: 0.87-1.45; depressive symptoms: β = 0.81, 95 % CI: 0.49-1.14; anxiety symptoms: β = 0.64, 95 % CI: 0.33-0.95).
Conclusions
Our study showed that participants with hyperopia, astigmatism, and reduced corrected visual acuity had a higher risk of mental health disorders than those with emmetropia or myopia. Furthermore, individuals with moderate-to-high myopia exhibited an increase in depressive or anxiety symptoms.
DOI: 10.1016/j.jad.2025.120317
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Janelle Scully is a clinical optometrist with a Bachelor of Optometry from the University of Melbourne. Currently she is the Manager of Ocular Disease and Diagnostic Services at ACO Eye Health. She maintains a keen interest in paediatric eyecare and supervises final year optometry students in both ocular disease and paediatric clinics. |
