Illness perceptions and psychosocial factors as determinants of fear of progression in patients with corneal ulcers: a cross-sectional study

As a leading global cause of corneal blindness, corneal ulcers may induce progressive tissue damage and permanent visual impairment. This visual morbidity may foster a profound fear of progression (FoP) in patients. Excessive FoP can adversely affect patients’ physical and mental well-being, as well as their social functioning. Therefore, this study aimed to investigate FoP levels and influencing factors of FoP among patients with corneal ulcers. In this quantitative study, a convenience sample of 180 patients with corneal ulcers was recruited from the corneal wards of a provincial tertiary ophthalmology hospital in eastern China between July 2024 and June 2025. Data were collected using validated scales: the General and Disease Information Questionnaire, the Fear of Progression Questionnaire (scores ≥ 34 indicated clinically significant dysfunctional FoP), the Brief Illness Perception Questionnaire, the Medical Coping Modes Questionnaire, and the Perceived Social Support Scale. Two researchers independently entered and verified the data. A multiple linear regression analysis was conducted using SPSS 26.0 to identify factors influencing FoP. The mean total score of FoP among patients was 27.61 ± 8.09, indicating a moderate level. Notably, 51 patients (28.3%) scored above the clinical cutoff of 34 points, suggesting a state of clinically significant fear of progression. The regression analysis identified age( β = -0.129, 95CI[-0.197,-0.060], P < 0.001), illness perception( β = 0.128, 95CI[0.123,0.333], P < 0.001), avoidance coping( β = 0.395, 95CI[0.109,0.682], P = 0.007), and resignation coping( β = 0.907, 95CI[0.571,1.243], P < 0.001) as significant influencing factors of FoP. FoP is prevalent at a moderate level among patients with corneal ulcers. The key modifiable factors include illness perception and the use of avoidance or resignation coping strategies. Clinical healthcare providers should enhance monitoring of psychological distress, particularly among younger patients, improve patient education to foster realistic illness perceptions, promote adaptive coping strategies, and implement targeted interventions to alleviate FoP.