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MR Agarwal, SE Feldon, V Nguyen; Clinical Features of Graves' Ophthalmopathy in a Latino Incidence Cohort . Invest. Ophthalmol. Vis. Sci. 2002;43(13):337.
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Purpose: The clinical features of Graves’ ophthalmopathy include eyelid retraction, lagophthalmos, eyelid lag, exophthalmos, restrictive extraocular myopathy, and optic neuropathy. After an extensive review of the literature, we found no studies of Graves’ ophthalmopathy in Latinos. Therefore, we investigated the frequency of clinical features of Graves’ ophthalmopathy in Latinos. Methods: We retrospectively reviewed the incident cases of 35 Latino patients with Graves’ ophthalmopathy seen at the Doheny Eye Institute and the USC/Los Angeles County Medical Center between 1982 and 1999. The median age at the time of diagnosis of Graves’ ophthalmopathy of the 25 females (71%) and 10 males (29%) was 54 years, with minimum and maximum ages of 18 and 70 years, respectively. The patients were determined to have Graves’ ophthalmopathy based on the Bartley classification. Both parents of each patient in the study were of Latino descent. Results: Of the 35 patients with Graves’ ophthalmopathy, 30 (86%) had Graves’ hyperthyroidism, 2 (6%) had Hashimoto’s thyroiditis, and 3 (8%) were euthyroid. At some time in their clinical course, 19 patients (54%) had eyelid retraction, 17 (48%) had exophthalmos, 15 (43%) had restrictive extraocular myopathy, and 1 (3%) had optic neuropathy. Only one patient (3%) had the whole constellation of features, including eyelid retraction, restrictive eye disease, exophthalmos, optic neuropathy, and Graves’ disease. Conclusion: Since there is a complete lack of data on ocular findings in the Latino community, the National Advisory Eye Council has recommended that prevalence surveys be conducted on minority groups such as Latinos to obtain information about ocular disease in these groups. The most common clinical feature of Graves’ ophthalmopathy found in Latinos is lid retraction. This is followed by exophthalmos, and restrictive extraocular myopathy. Optic neuropathy is uncommon, as is having the complete constellation of features. Our results differ from those of the Bartley study in which all patients are white. There is a significant difference between the prevalence of lid retraction in our Latino patients (54%) when compared to Bartley’s white patients (90%, p < 0.001). However, there is no significant difference when our patients are compared to his patients with exophthalmos (p = 0.24), restrictive extraocular myopathy (p = 1.00), and optic nerve dysfunction (p = 0.68). We recommend conducting larger prospective studies to further evaluate genetic and clinical factors that may account for these differences in the Latino population.
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