Does Graves’ Orbitopathy Ever Disappear Answers to an Old Question

Sabini, Elena; Leo, Marenza; Mazzi, Barbara; Rocchi, Roberto; Latrofa, Francesco; Nardi, Marco; Vitti, Paolo; Marcocci, Claudio; Marinò, Michele

doi:10.1159/000477803

Cited by 22 publications

(13 citation statements)

References 24 publications

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“…After approximately 1–3 years, TED becomes chronic and less active with varying levels of long-term sequelae, such as proptosis and diplopia [ 3 , 4 ]. Only about 2% of patients with moderate-to-severe TED are ever considered to be free of TED [ 5 ], which will hopefully change with newer, more targeted therapies. Therefore, many patients experience significant changes in their quality of life (QOL) due to changes in their appearance, visual alterations, inability to cope, and mental/psychiatric manifestations [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Physician-Perceived Impact of Thyroid Eye Disease on Patient Quality of Life in the United States

et al. 2020

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Introduction Thyroid eye disease (TED) is an autoimmune disease that causes retro-orbital inflammation and subsequent proptosis, corneal exposure, strabismus, and variable vision changes. European studies have shown that TED can severely impact quality of life (QOL), but little is known about the QOL of patients with TED in the USA. Given that patient QOL influences TED severity classifications and subsequent treatment, understanding physician-perceived patient QOL is extremely important. Methods This retrospective chart review (conducted in 2018) examined QOL in US patients with moderate-to-severe TED, as reported by treating physicians who regularly manage patients with TED (≥ 5 patients in prior 12 months). The physicians graded patients’ overall QOL (7-point Likert scale; 1 = “not at all impaired”, 7 = “extremely impaired”), assessing mental health, vision changes, and ocular structural signs/symptoms. Patient demographics and clinical findings were examined to understand the impact of disease presentation on physician-perceived QOL. Results Medical record data of 714 US patients with moderate-to-severe TED were provided by 181 physicians (73 endocrinologists, 108 ophthalmologists). Patients had a mean age of 49.4 (standard deviation [SD] 13.6) years, and 102 cases (14%) were severe. Anxiety and/or depression was reported in 36% of patients (an increase from the 18.9% prevalence reported for the USA in 2017 by the US National Institute of Mental Health; P < 0.001). The mean physician-reported QOL impact score was 4.1 (SD 1.5). Furthermore, 62 and 89% of patients with moderate and severe TED, respectively, had a high physician-perceived QOL impact (≥ 4). The higher QOL impact group had significantly higher rates of pain symptoms, visual disturbances (including diplopia), and orbito-facial structural changes. Higher disease activity and severity were associated with lower physician-perceived QOL. Conclusion Patients’ QOL, as evaluated by US physicians, is highly impacted by the activity and severity of TED. Additionally, mental health issues were more frequently reported by patients with TED than in the general US population. Ocular pain, strabismus, and diplopia appear to be main drivers of physician-perceived QOL impairment in this sample of US patients with TED.

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Section: Introductionmentioning

confidence: 99%

Physician-Perceived Impact of Thyroid Eye Disease on Patient Quality of Life in the United States

et al. 2020

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“…Thyroid-associated ophthalmopathy (TAO) is a long-lasting, chronic orbital disease, which is associated with a combination of environmental, genetic, and immunological factors [1–3]. Ocular surface impairment in TAO, such as conjunctival hyperemia and chemosis, dry eye, superficial punctate keratopathy, exposure keratopathy, and corneal ulcer, is common [4–6].…”

Section: Introductionmentioning

confidence: 99%

Altered Corneal Nerves in Chinese Thyroid-Associated Ophthalmopathy Patients Observed by In Vivo Confocal Microscopy

Mou

Chen

et al. 2019

Med Sci Monit

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BackgroundThyroid-associated ophthalmopathy (TAO) is a common endocrine autoimmune disease. The present study explored corneal nerve changes in TAO patients.Material/MethodsThirty-eight Chinese TAO patients and 20 healthy individuals were included in the study. Central corneal subbasal nerve density and morphology were evaluated with in vivo laser scanning confocal microscopy and quantified using automated CCmetrics software.ResultsThe values of the central corneal subbasal nerve plexus parameters of both active and inactive TAO patients were significantly decreased compared with those of controls, including corneal nerve fiber density (CNFD) (P<0.001 for both), corneal nerve branch density (CNBD) (P<0.001 for both), corneal nerve fiber length (CNFL) (P<0.001 for both), corneal nerve fiber total branch density (CTBD) (P<0.001 for both), corneal nerve fiber area (CNFA) (P<0.001 for both), corneal nerve fiber width (CNFW) (P=0.046, P=0.027, respectively), and corneal nerve fiber fractal dimension (ACNFrD) (P<0.001 for both). In addition, CNFD and ACNFrD values were significantly lower in the active TAO patients compared with those in the inactive TAO patients (P=0.020, P=0.002, respectively). There were significant correlations between CNFD, CNBD, CNFL, CTBD, CNFA, and ACNFrD and the ocular surface parameters and activity assessment items.ConclusionsAbnormal corneal subbasal nerves were observed in both active and inactive Chinese TAO patients, suggesting that nerve degeneration is associated with the disease. However, the exact underlying mechanisms remain to be elucidated.

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“…Graves' orbitopathy (GO) is an in ammatory autoimmune disorder, that is associated with a combination of environmental, genetic, and immunological factors [1][2][3]. Ocular surface impairment is common in patients with GO, including conjunctival hyperemia and chemosis, dry eye, super cial punctate keratopathy, exposure keratopathy, and corneal ulcer [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves’ orbitopathy

Cheng

Chen

et al. 2020

Preprint

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Background: To evaluate microstructural changes in the meibomian glands (MGs) in patients with active and inactive Graves’ orbitopathy (GO), using in vivo confocal microscopy (IVCM), and to investigate the correlations between clinical and confocal findings.Methods: Forty patients (80 eyes) with GO (34 eyes with active GO, 46 eyes with inactive GO), and 31 age- and sex-matched control participants (62 eyes) were enrolled consecutively. Each participant completed an Ocular Surface Disease Index (OSDI) questionnaire and underwent a full eye examination, including assessments of clinical activity score (CAS), proptosis, palpebral fissure height (PFH), lagophthalmos, lipid layer thickness (LLT), partial blinking rate, noninvasive first breakup time (NIF-BUT), average breakup time (NIAvg-BUT), tear film breakup area (TBUA), corneal fluorescein staining (CFS), Schirmer I Test (SIT), meibum quality and MG expressibility. IVCM of the MGs was performed to determine the MG acinar density (MAD), MG longest and shortest diameters (MALD and MASD), MG orifice area (MOA), MG acinar irregularity (MAI), meibum secretion reflectivity (MSR), acinar wall inhomogeneity (AWI), acinar periglandular interstices inhomogeneity (API), and severity of MG fibrosis (MF).Results: All parameters demonstrated statistically significant differences among groups (all P＜0.05), except OSDI, LLT and NIAvg-BUT (P＞0.05). Compared to controls, GO groups showed lower MOA and MAD; greater MALD and MASD; and higher degrees of MAI, MSR, AWI, API, and MF (all P＜0.05). Eyes with active GO had higher degrees of MAI, AWI, and API, while eyes with inactive GO had higher degrees of MSR and MF (all P＜0.05). In GO groups, the two measured confocal signs of inflammation (AWI and API) were significantly correlated with CAS, proptosis, PFH, lagophthalmos, OSDI, NIF-BUT, CFS, SIT, meibum quality, and MG expressibility (all P＜0.05). MF was significantly correlated with CAS, OSDI, meibum quality, and MG expressibility (all P＜0.05). Conclusions: IVCM effectively revealed microstructural changes of MGs in eyes with GO and provided strong in vivo evidence for the roles of obstruction and inflammation in the ocular surface disease process. Furthermore, it revealed discernible patterns of MG abnormalities in eyes with active GO and inactive GO, which are not easily distinguishable by typical clinical examinations.

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Does Graves’ Orbitopathy Ever Disappear Answers to an Old Question

Cited by 22 publications

References 24 publications

Physician-Perceived Impact of Thyroid Eye Disease on Patient Quality of Life in the United States

Physician-Perceived Impact of Thyroid Eye Disease on Patient Quality of Life in the United States

Altered Corneal Nerves in Chinese Thyroid-Associated Ophthalmopathy Patients Observed by In Vivo Confocal Microscopy

In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves’ orbitopathy

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