Reliability of exophthalmos measurement and the exophthalmometry value distribution in a healthy Dutch population and in Graves' patients. An exploratory study

Mourits, Maarten P.; Lombardo, Stefano; Sluijs, F A van der; Fenton, Sinead

doi:10.1080/01676830490504089

Cited by 70 publications

(44 citation statements)

References 14 publications

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“…All patients were examined by the same ophthalmologist at week 0, 4, 8 and 12 before the first infusion on (20), for which the NOSPECS class 3 was adapted, with a subdivision for male and female. The eyelid aperture was measured with a ruler as the distance in the midline between the eyelids.…”

Section: Assessment Of Efficacymentioning

confidence: 99%

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Geest¹,

Sasim²,

Koppeschaar³

et al. 2008

European Journal of Endocrinology

109

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Objective: To assess whether methylprednisolone (MP) pulse therapy is efficacious in the treatment of moderately severe Graves' orbitopathy (GO). Design: Prospective, placebo (PL)-controlled, double-blind, randomized study. Methods: Fifteen previously untreated patients with active, moderately severe GO participated in the study; 6 patients received MP and 9 patients a PL. Moderately severe disease was defined using the NOSPECS classification of clinical signs of GO . Activity was measured with the clinical activity score (CAS). A dose of 500 mg MP or only solvent was administered intravenously, over three consecutive days, in four cycles at 4 weekly intervals (6 g of MP in total). Qualitatively, a successful treatment outcome was defined as an improvement in one major and/or two minor criteria in the worst eye at week 48. The major criteria were: improvement in diplopia grade; improvement in eye movement; a decrease in CAS of three points. The minor criteria were: decrease of eyelid retraction; decrease of proptosis; improvement in grade of soft tissue swelling; a decrease in CAS of two points. Results: The qualitative treatment outcome was successful at the end of the trial in five out of six (83%) patients receiving MP and in one out of nine (11%) patients given the PL (relative riskZ7.5; (95% confidence interval 1.1-49.3), PZ0.005). The treatment was well tolerated. Conclusions: In spite of the small number of patients, a significant difference in outcome was observed between MP-and PL-treated patients. We conclude that MP pulse therapy appears to be an effective treatment for active, moderately severe GO.European Journal of Endocrinology 158 229-237

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Section: Assessment Of Efficacymentioning

confidence: 99%

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Geest¹,

Sasim²,

Koppeschaar³

et al. 2008

European Journal of Endocrinology

109

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“…Measurements can be performed by exophthalmometry, 36 and normative measurements based on age have been reported in children. 37,38 Although there is interobserver reliability of exophthalmometry in healthy adults with and without Graves disease, 39 there is no known large study examining exophthalmometry in children with orbital tumors. In contrast, proptosis has been measured successfully and serially using MRI in children with optic nerve gliomas 40 and may be a more accurate method of measuring the degree of proptosis; however, a recent study demonstrated that improvement in proptosis did not correlate with tumor shrinkage.…”

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confidence: 99%

Functional outcome measures for NF1-associated optic pathway glioma clinical trials

et al. 2013

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Objective: The goal of the Response Evaluation in Neurofibromatosis and Schwannomatosis Visual Outcomes Committee is to define the best functional outcome measures for future neurofibromatosis type 1 (NF1)-associated optic pathway glioma (OPG) clinical trials. Methods:The committee considered the components of vision, other ophthalmologic parameters affected by OPG, potential biomarkers of visual function, and quality of life measures to arrive at consensus-based, evidence-driven recommendations for objective and measurable functional endpoints for OPG trials.Results: Visual acuity (VA) assessments using consistent quantitative testing methods are recommended as the main functional outcome measure for NF1-OPG clinical trials. Teller acuity cards are recommended for use as the primary VA endpoint, and HOTV as a secondary endpoint once subjects are old enough to complete it. The optic disc should be assessed for pallor, as this appears to be a contributory variable that may affect the interpretation of VA change over time. Given the importance of capturing patient-reported outcomes in clinical trials, evaluating visual quality of life using the Children's Visual Function Questionnaire as a secondary endpoint is also proposed. Conclusions:The use of these key functional endpoints will be essential for evaluating the efficacy of future OPG clinical trials. Neurology ® 2013;81 (Suppl 1):S15-S24 GLOSSARY CVFQ 5 Children's Visual Function Questionnaire; logMAR 5 logarithm of the minimum angle of resolution; MS 5 multiple sclerosis; NF1 5 neurofibromatosis type 1; OCT 5 optical coherence tomography; OPG 5 optic pathway glioma; PFS 5 progression-free survival; QOL 5 quality of life; REiNS 5 Response Evaluation in Neurofibromatosis and Schwannomatosis; RNFL 5 retinal nerve fiber layer; TAC 5 Teller acuity cards; VA 5 visual acuity; VEP 5 visual evoked potential; VF 5 visual field.Optic pathway gliomas (OPG) arise in 15%-20% of children with neurofibromatosis type 1 (NF1), occur preferentially in young children compared with adolescents or adults, and cause vision loss in as many as half of those affected.1 In this regard, the main objective in clinical management of these tumors is preservation of visual function. Although prognostic factors have been identified, there are currently no reliable indicators of future visual loss. This absence of prognostic signs has led clinicians to avoid initiating treatment until visual function has declined. When treatment is indicated, NF1-OPG are typically managed with a combination of carboplatin and vincristine-an approach that has not changed in 15 years. 2To date, OPG clinical trials have focused on imaging outcomes, with tumor response and/or progression-free survival used as measures of treatment success.

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“…For example, an exophthalmos ≥19 mm in men or ≥17 mm in women may be observed in otherwise normal subjects. However, several studies have shown that exophthalmometry values in normal subjects are on average 15 ± 1 mm [14][15][16][17][18], with higher values in men than in women. Thus, the cutoff values we arbitrarily establish should reflect the normal values of the general population plus two standard deviations.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, even with a long follow-up time, evaluation by physicians can be hampered by a series of confounding factors on what the definition of a normal eye is. For example, a normal eye protrusion range is somehow established [14][15][16][17][18], but patients may have constitutional or myopic exophthalmos that may not be distinguishable from GO exophthalmos. The issue of GO disappearance was investigated in two previous studies, but none of them considered disappearance of GO from both the clinician's and the patient's points of view [19,20].…”

Section: Introductionmentioning

confidence: 99%

Does Graves’ Orbitopathy Ever Disappear Answers to an Old Question

et al. 2017

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Objectives: There is a general belief that Graves' orbitopathy (GO) is a "chronic" disease, namely that patients' eyes do not return to how they were before GO appeared. Here, we investigate this issue from both the patient's and the physician's point of view. Study Design: We studied the disappearance of GO, regardless of treatment, in all consecutive patients with a GO history of at least 10 years who came for a follow-up visit over a period of 5 years. Patients underwent an ophthalmological examination and were asked to answer a questionnaire on self-perception related to GO. Results: We studied 99 consecutive patients with a GO duration ≥10 years. Between the first and the last observation, patients received several types of treatment for their thyroid disease and/or for GO. At the end of follow-up, GO was considered disappeared based on objective criteria in 8 patients (∼8%) and based on subjective criteria in 24 patients (∼24%). When we considered both subjective and objective criteria, only 2 patients (∼2%) had all criteria fulfilled and could be considered as GO-free. Conclusions: GO is a chronic disease in the vast majority of patients. Even after a very long time since its onset, complete disappearance is rare, although a minority of patients believe they do not have GO anymore and an even lower proportion do not have relevant GO signs. Our findings have obvious implications in patient management and counseling.

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Reliability of exophthalmos measurement and the exophthalmometry value distribution in a healthy Dutch population and in Graves' patients. An exploratory study

Abstract: Exophthalmometry is reliable and absolute measurement of proptosis is feasible. International standardization of Hertel exophthalmometry is required in order to compare exophthalmometry data in the literature reliably.

Cited by 70 publications

References 14 publications

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Functional outcome measures for NF1-associated optic pathway glioma clinical trials

Does Graves’ Orbitopathy Ever Disappear Answers to an Old Question

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