Psychiatry of ophthalmology: Proposing the ophthalmo-psychiatric disorders framework

We propose the ophthalmo-psychiatric disorders (OPD) framework as an organizing clinical and research model at the interface of vision science and mental health, and to synthesize, with wording calibrated to evidence strength, bidirectional relationships between ophthalmic disease, visual function, and psychiatric states. Visual impairment and common mental disorders co-distribute globally, with adults with vision loss showing roughly two-to three-fold higher prevalence of depressive and anxiety symptoms than visually normal peers. Elevated psychiatric comorbidity across glaucoma, dry eye disease, and age-related macular degeneration is supported by systematic reviews and meta-analyses, as is the benefit of psychological and stepped-care intervention. Mechanistic claims are weaker: hypothalamic-pituitary-adrenal and autonomic dysregulation, inflammation, circadian disruption, central sensitization, and retinal neurodegeneration remain candidate pathways resting largely on cross-sectional data, and retinal findings in severe mental illness are group-level associations confounded by lifestyle, metabolic, medication, and imaging factors. The eye and the mind are anatomically and physiologically connected. The concept of OPD provides a pragmatic biopsychosocial framework that moves beyond an "organic versus non-organic (functional)" dichotomy and highlights the clinical intersection of the 2 fields. Progress will depend on interdisciplinary training, longitudinal research with harmonized definitions, and culturally sensitive implementation of eye-mind care.