Subclinical dysthyroid optic neuropathy: tritan deficiency as an early sign of dysthyroid optic neuropathy

2020 ◽  
pp. bjophthalmol-2020-316433
Author(s):  
Aylin Garip-Kuebler ◽  
Kathrin Halfter ◽  
Lukas Reznicek ◽  
Annemarie Klingenstein ◽  
Siegfried Priglinger ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Colour Vision ◽  
Definitive Diagnosis ◽  
Early Sign ◽  
Dysthyroid Optic Neuropathy ◽  
Graves Orbitopathy ◽  
The Mean ◽  
Pathological Sign ◽  
Optic Nerve Compression

PurposeThe aim of this research was to investigate the subclinical findings of dysthyroid optic neuropathy (DON) and to look for early indicators for optic nerve compression in patients with Graves’ orbitopathy.Patients and MethodsIn this observational, retrospective study, the medical charts of 24 patients (32 eyes) with a diagnosis of DON between 2008 and 2019 were included. Our goal was to identify potential pathological signs in patients with DON prior to the definitive diagnosis of DON.ResultsWe discovered that the earliest pathological sign in the subclinical cases was tritan deficiency obtained with a standardised colour vision test by Arden. In all cases but one, regardless of the visual field (VF) defects, the tritan values were pathological (based on a threshold of ≥8%) in the subclinical phase. The mean tritan value was 19.12% (range 6.9–80.8%) at the time of the subclinical phase and 32.16% (range 6.3–100.0%) at the time of the diagnosis of DON. The sensitivity of the colour vision test was 20% for protan and 96.67% for tritan in the subclinical phase. At the time of the definitive diagnosis of DON, the sensitivity of protan was 48.15% compared to 96.30% for tritan.ConclusionWe found that changes in vision affecting the blue-yellow (tritan) colours resulting from the compression of optic nerve, even in affected patients with normal VF tests, are a reliable early sign of DON.

scholarly journals Orbital Volumetry in Graves' Orbitopathy: Muscle and Fat Involvement in relation to Dysthyroid Optic Neuropathy

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Moug Al-Bakri ◽  
Åse Krogh Rasmussen ◽  
Carsten Thomsen ◽  
Peter Bjerre Toft
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Ct Scans ◽  
Orbital Decompression ◽  
Orbital Fractures ◽  
Relative Significance ◽  
Dysthyroid Optic Neuropathy ◽  
Orbital Fat ◽  
Graves Orbitopathy ◽  
Fat Volume

Purpose. We wanted to investigate the relative significance of fat and muscle enlargement in the development of dysthyroid optic neuropathy (DON) in Graves’ orbitopathy (GO). Methods. Preoperative coronal CT scans of 13 patients with and without DON who subsequently underwent orbital decompression were retrospectively analyzed. Thirteen patients imaged for unilateral orbital fractures served as controls. Results. The retrobulbar muscle volume was 2.1 ± 0.5 cm3 (mean ± SD) in controls, 4.3 ± 1.5 cm3 in GO without DON, and 4.7 ± 1.7 cm3 in GO with DON. The retrobulbar fat volume was 5.4 ± 1.6 cm3 in controls, 8.7 ± 8.0 cm3 in GO without DON, and 9.4 ± 3.1 cm3 in GO with DON. The muscle and fat volumes were higher in patients with GO than in controls (P<0.001), but the volumes in orbits with and without DON were not significantly different. The volume of the optic nerve were similar in the 3 groups. The number of apical, coronal 2 mm thick slices with no fat was 2.9 ± 0.9 in normal orbits, it was 4.1 ± 1.0 in GO orbits without DON and 5.3 ± 0.8 in GO orbits with DON (P=0.007). Conclusion. Apical muscle enlargement may be more important than orbital fat enlargement in the development of DON. However, the fact that apical crowding and muscle enlargement also occur in orbits without DON suggests that other factors also play a role in the development of DON.

scholarly journals A pathological indicator for dysthyroid optic neuropathy: tritan color vision deficiency

2021 ◽  
Author(s):  
Aylin Garip Kuebler ◽  
Kathrin Halfter ◽  
Lukas Reznicek ◽  
Annemarie Klingenstein ◽  
Siegfried Priglinger ◽  
...  
Keyword(s):  
Color Vision ◽  
Optic Neuropathy ◽  
Medical Records ◽  
Visual Field Defects ◽  
Full Spectrum ◽  
Dysthyroid Optic Neuropathy ◽  
Corrected Visual Acuity ◽  
Color Vision Test ◽  
The Mean ◽  
Pathological Sign

Abstract Purpose To investigate the sensitivity of the color vision test by Arden in patients with dysthyroid optic neuropathy (DON) to improve diagnosis. Methods In this observational, retrospective study, we included the medical records of 92 eyes (48 patients) with diagnosis of DON between 2008 and 2019 in order to evaluate the full spectrum of findings from the color vision test by Arden, and to determine potential importance of this test. Thirty-five patients were female, and 13 patients were male. The mean age was 58.0 years (range: 34–79) at the time of the DON diagnosis. Results Forty-one eyes displayed relatively good BCVA with ≤ 0.2 LogMAR. We found a protan value exceeding the threshold of ≥ 8% in 57 eyes (30 patients) at the time of the diagnosis. The sensitivity of protan was 61.9% (95% CI 51.2–71.8%), while that of tritan was a striking 98.9% (95% CI 94.1–99.9%). We discovered one pathological sign, tritan deficiency (based on a threshold of ≥ 8%) consistently in all eyes but one at the time of the diagnosis, regardless of the visual field defects or any changes in best-corrected visual acuity (BCVA). Conclusion We found blue-yellow (tritan) deficiency, to be a sensitive and reliable indicator of dysthyroid optic neuropathy. We conclude that, in cases with suspected DON, a color vision test that can detect tritan deficiency is an essential tool for the adequate assessment, diagnosis, and treatment of DON.

Compressive Optic Neuropathy

2011 ◽  
pp. 21-24
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak ◽  
Robert B. Daroff
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Clinical Signs ◽  
Monocular Vision ◽  
Compressive Optic Neuropathy ◽  
Imaging Characteristics ◽  
Optic Nerve Sheath Meningioma ◽  
Common Causes ◽  
Optic Nerve Compression

Optic nerve compression results in progressive, and often painless, monocular vision loss. In this chapter, we review the clinical signs and common causes of compressive optic neuropathy. We discuss in more detail the imaging characteristics and management of optic nerve sheath meningioma.

“Balanced” Orbital Decompression for Severe Graves' Orbitopathy: Technique with Treatment Algorithm

2003 ◽  
Vol 128 (2) ◽  
pp. 228-235 ◽  
Author(s):  
Kacker Ashutosh ◽  
Kazim Michael ◽  
Murphy Mark ◽  
Trokel Stephen ◽  
G. Close Lanny
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Treatment Algorithm ◽  
Orbital Decompression ◽  
Nerve Function ◽  
Muscle Involvement ◽  
Compressive Optic Neuropathy ◽  
Average Decrease ◽  
Graves Orbitopathy ◽  
Low Incidence

BACKGROUND: Graves' orbitopathy can produce proptosis, compressive optic neuropathy, and extraocular motility abnormalities; symptoms result from an increase in orbital volume due to expansion of intraorbital fat, with or without extraocular muscle involvement. STUDY DESIGN: We conducted a chart review of patients who underwent orbital decompression to treat Graves' orbitopathy. Twenty-two orbits (13 patients) underwent orbital bone decompression, of which 17 orbits (9 patients) underwent the combined medial and lateral “balanced” decompression. RESULTS: All patients had significant improvement with an average decrease in proptosis of 5.9 mm in the balanced decompression group. Restoration of normal optic nerve function was achieved in all patients with compressive optic neuropathy. Diplopia was noted in 4 patients (30.7%) preoperatively. Two patients had new postoperative diplopia (15.35%). CONCLUSION: In our experience, “balanced” decompression results in a reduction of proptosis and improved optic nerve function and has a low incidence of complications.

scholarly journals Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy

Clinics ◽  
2012 ◽  
Vol 67 (11) ◽  
pp. 1327-1334 ◽  
Author(s):  
ACP Gonçalves ◽  
EM Gebrim ◽  
ML Monteiro
Keyword(s):  
Optic Neuropathy ◽  
Imaging Studies ◽  
Dysthyroid Optic Neuropathy ◽  
Graves Orbitopathy

scholarly journals Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey

2006 ◽  
Vol 91 (4) ◽  
pp. 455-458 ◽  
Author(s):  
D. McKeag ◽  
C. Lane ◽  
J. H Lazarus ◽  
L. Baldeschi ◽  
K. Boboridis ◽  
...  
Keyword(s):  
Clinical Features ◽  
Optic Neuropathy ◽  
Dysthyroid Optic Neuropathy ◽  
Graves Orbitopathy ◽  
European Group
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