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Double vision main indication for therapy in half of patients with Graves' orbitopathy
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CORONADO, Calif. — The main indication for therapy was double vision in around half of patients with moderate to severe Graves’ orbitopathy, according to study findings presented at the American Thyroid Association Annual Meeting.
Peter Laurberg, MD, MSc, and colleagues from the department of endocrinology and ophthalmology at Aalborg University Hospital in Denmark, evaluated 210 patients with incident moderate to severe Graves’ orbitopathy. Grid-based planimetry from charts was used to measure fields of double vision and motility restriction.
Peter Laurberg
Only about one in four patients had no double vision, whereas 75.1% of patients had double vision ranging from 5% to 100%. Those with double vision ≥50% were mean aged 54 years; 77.7% were women.
No correlation was found with age, race, sex, duration of disease or smoking status. However, a positive correlation was found between eye motility restriction (P<.001) and asymmetry of Graves’ orbitopathy (P<.001). A negative correlation was found with inflammation (P<.001) and proptosis (P<.001), which was unexpected as these symptoms are often used as measures of outcomes in studies that assess the need for therapy.
“Patients with more severe orbital autoimmunity tend to have a more universal and symmetrical affection of the orbits,” Laurberg said. “On the other hand, patients with less severe autoimmunity may have more isolated affection of one eye muscle and thus, more diplopia. This diversity may be due to binocular coupling of eye movements. Quantitative recording of field of double vision is advisable both in individual patients and in controlled studies of patients with Graves’ orbitopathy.”
For more information:
Laurberg P. Oral #1. Presented at: American Thyroid Association Annual Meeting; Oct. 29-Nov. 2, 2014; Coronado, Calif.
Disclosure: The researchers report no relevant financial disclosures.
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Rebecca S. Bahn, MD
This abstract is about double vision in patients with Graves’ orbitopathy. It’s a study done by Dr. Peter Laurberg and his colleagues from Aalborg University in Denmark. They followed some 215 patients prospectively who presented to their institution with moderate to severe Graves’ orbitopathy and very carefully measured the patients double vision. Later on, they looked at the degree of inflammation of the eyes that those patients had and also the indications for starting specific therapies. They found that double vision was really the indication for therapy in about half of the patients, which goes counter, to some extent, what one might imagine.
When you think about it, patients are treated most often because of eye inflammation but what they found was that the double vision was the most common reason for treatment. There was also a negative correlation between ocular inflammation and the degree of double vision. In other words, the more inflammation the patients had, the less double vision they had and vice versa.
It suggests that patients who have double vision, which is a very serious problem for these patients and very difficult to treat, may be the patients who had the most inflammation early on.
In future clinical studies of these patients it will be important to carefully measure double vision and look at that as one of the endpoints, and not just look at inflammation and degree of proptosis. We as clinicians and also people who do clinical studies in this area have to remember that double vision and careful assessment of double vision is really essential.
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