{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T08:39:09Z","timestamp":1770885549142,"version":"3.50.1"},"reference-count":39,"publisher":"SLACK, Inc.","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Refract Surg"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec><jats:title>PURPOSE:<\/jats:title><jats:p>To investigate hair cortisol concentration (HCC), a biochemical correlate of chronic psychological stress, and its relationship to the progression of keratoconus.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>Eighty-six participants were included in this prospective observational study (32 patients with progressive keratoconus, 32 patients with stable keratoconus, and 22 healthy controls). Hair cortisol concentrations were determined from 3-cm hair strands collected near the scalp from patients and controls as an index of cumulative cortisol secretion during the 3-month period prior to hair sampling. In addition, self-reported chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress screening scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Patients with progressive keratoconus exhibited higher hair cortisol concentrations (mean value: 29.11 pg\/mg; 95% confidence interval [CI]: 22.13 to 38.28) than patients with stable keratoconus (mean value: 15.88 pg\/mg; 95% CI: 12.25 to 20.65;<jats:italic>P<\/jats:italic>= .007) and healthy controls (mean value: 16.98 pg\/mg; 95% CI: 12.30 to 23.44;<jats:italic>P<\/jats:italic>= .049). There were no significant differences in hair cortisol concentrations between healthy controls and patients with stable keratoconus (<jats:italic>P<\/jats:italic>= .991). Group differences were not affected by relevant covariates (body mass index, age, or sex).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>This study shows that increased hair cortisol concentration seems to be associated with the progression of keratoconus. There are a variety of causes of increased hair cortisol concentration.<\/jats:p><jats:p><jats:bold>[<jats:italic>J Refract Surg.<\/jats:italic>2017;33(6):383\u2013388.]<\/jats:bold><\/jats:p><\/jats:sec>","DOI":"10.3928\/1081597x-20170413-01","type":"journal-article","created":{"date-parts":[[2017,6,6]],"date-time":"2017-06-06T17:15:59Z","timestamp":1496769359000},"page":"383-388","source":"Crossref","is-referenced-by-count":21,"title":["Increased Hair Cortisol Concentrations in Patients With Progressive Keratoconus"],"prefix":"10.3928","volume":"33","author":[{"given":"Janine","family":"Lenk","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eberhard","family":"Spoerl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Stalder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susann","family":"Schmiedgen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Herber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lutz E.","family":"Pillunat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederik","family":"Raiskup","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2308","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000000408"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2010.06.012"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2011.09.009"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0378-4347(99)00416-8"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0379-0738(99)00146-2"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2012.02.002"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2013.01.003"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1026\/\/0012-1924.45.1.8"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2008.08.024"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.25011\/cim.v36i6.20629"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/toxsci\/kfn010"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2007.060225"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(70)90494-0"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e3181cb410b"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-9071.2001.d01-17.x"},{"key":"e_1_3_2_17_2","first-page":"786","article-title":"The effects of Ramadan fasting on the health and function of the eye","volume":"19","author":"Javadi MA","year":"2014","unstructured":"Javadi MA, Assadi M, Einollahi B, Rabei HM, Afarid M, Assadi M. 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