Editorial for “Functional and Morphological Brain Alterations in Dysthyroid Optic Neuropathy: A Combined Resting‐State fMRI and Voxel‐Based Morphometry Study”

Abstract

T hyroid eye disease (TED) is an inflammation of the orbit due to the loss of immune tolerance in the thyroid gland. 1 One of the complications of TED is dysthyroid optic neuropathy (DON)-a serious impairment of optic nerve function. 2 The most prominent clinical features of DON include profound loss in visual acuity, color vision deficiency, relative afferent pupillary defect, and fluid buildup in the optic disc. 3 A person with the disease may also complain of irritated eyes and pain with eye movements. If the disease is not treated timely, patients may experience progressive vision loss that may eventually lead to permanent blindness. Consideration of the pathological mechanism of DON has important implications for the treatment of the disease. Controversy still exists regarding the pathogenesis of DON as it appears to be multifactorial. 4 Recent neuroimaging studies reported alterations of the brain structure and function in regions associated with vision in DON patients. 5,6 Therefore, current evidence suggests that patients with DON may demonstrate neural alterations in the visual pathway of DON. However, the exact structural and functional brain network alterations in DON remain elusive.In this issue of JMRI, Zhang et al further examined the morphological and functional brain alterations in DON using resting-state functional MRI (rs-fMRI). 7 This method is widely used in neuroimaging studies to assess brain alterations in healthy and clinical populations. [8][9][10] To investigate the distinct brain alterations associated with DON, the authors acquired and compared functional volumes of 30 patients with DON, 40 patients with thyroid-associated ophthalmopathy (TAO) but without DON, and 21 healthy controls. It was hypothesized that 1) the DON patients would demonstrate structural and functional alterations in brain regions associated with vision, and 2) these alterations would correlate positively with the severity of the