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Catherine J. Choi, Susel Oropesa, Alison B. Callahan, Lora R Glass, Livia Teo, Michael Kazim, Suzanne K. Freitag; Patterns of visual field changes in thyroid eye disease. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5991.
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© ARVO (1962-2015); The Authors (2016-present)
To provide a systematic description of patterns of visual field changes in dysthyroid optic neuropathy (DON).
A retrospective, non-comparative review of patients age 18 or older at the time of diagnosis of DON, with documented 24-2 or 30-2 Humphrey Visual Field (HVF) testing between April 1991 and July 2015 at the Massachusetts Eye and Ear Infirmary and Edward S. Harkness Eye Institute of Columbia University was conducted with IRB approval. 100 visual fields in 68 patients between the ages of 35 and 87 with fixation loss <20% and false positives and negatives <33% were included. In an abnormal VF, at least three consecutive points on pattern deviation plot depressed by 5 dB level or more were required. Abnormal VFs were then classified as one of the 17 mutually exclusive pre-specified patterns from the Ocular Hypertension Treatment Study (OHTS) (altitudinal, arcuate, nasal step, paracentral, partial arcuate, temporal wedge, central, hemianopia, inferior depression, partial hemianopia, partial peripheral rim, peripheral rim, quadrant, superior depression, total loss, vertical step, and widespread) or “other”.
The five most common patterns were other (27%), partial arcuate (26%), partial peripheral rim (10%), arcuate (8%) and altitudinal (7%). Average mean deviations for the five most common patterns were: other -4.82 dB +/-5.68, partial arcuate -6.32 dB+/- 3.41, partial peripheral rim -5.67 dB +/- 1.78, arcuate -13.5 dB +/- 11.8, and altitudinal -11.5 dB +/- 6.16. Further sub-classification showed a predominance of inferior VF defects, ranging from 40% to 93% of each category (Table 1, Figure 1). Of the 78 VFs in these five categories combined, 53 (68%) were inferior VF defects.
This study was the first application of systematic classification of VF in DON using a validated method. While the OHTS VF categories are geared towards classification of glaucomatous patterns, the predominance of a spectrum of inferior VF defects in DON was demonstrated. This is thought to be consistent with the anatomy of the orbital apex where the position of the optic nerve within the lesser wing of the sphenoid in relation to the annulus of Zinn places the superior aspect of the optic nerve closest to the enlarged extraocular muscles. The high proportion of VF falling under the “other” category, however, does demonstrate the need for a more specific and tailored VF classification system for DON.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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