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Taylor W Starnes, Mohsin Ali, Peter W Macintosh, Pete Setabutr, Heather E Moss, Vinay Kumar Aakalu; Quantitative Analysis of Goldmann Visual Fields Following Orbital Decompression for Thyroid Eye Disease. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5160. doi: https://doi.org/.
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There is a well-established role for orbital decompression in patients with compressive optic neuropathy due to thyroid eye disease (TED). We performed a retrospective, observational study to evaluate visual rehabilitation following orbital decompression for TED using Goldmann visual fields (GVF). This is the first study to quantitatively evaluate the post-operative GVF changes following orbital decompression for TED.
Patients who were undergoing orbital decompression at the Illinois Eye and Ear Infirmary received complete eye examinations, including Goldmann perimetry, preoperatively and at post-operative visits. Inclusion criteria were TED with presumed optic neuropathy, baseline acuity better than 20/200, and no confounding diagnoses (including glaucoma, other optic neuropathy, and advanced retinal disease). All Goldmann fields were performed with the I4e and I2e isopters, the outlines of each isopter were traced with the magic wand tool in Photoshop®, and the enclosed area was calculated (Figure 1A). Field areas, visual acuity, and color testing were followed from the pre- to post-operative visits and trends were compared.
Five eyes from 3 patients were included in the pilot study. There was substantial variability in the pre-op field areas (Range 2.91-17.09cm2); therefore, the fold change from baseline was used to follow the post-operative trends. The mean field area for the I2e isopter increased by 1.30 ± 0.61 fold at post-op month 3 and by 1.80 ± 0.60 fold at post op month 12 (Figure 1B). The mean field area for the I4e isopter was 1.07 ± 0.07 fold of the pre-op area at post-op month 12. Mean pre-operative visual acuity was LogMAR 0.42, which improved to 0.18 at post-op month 12. The mean pre-op score on Ishihara plates was 6.7 ± 4.1 out of 11, which improved to 11/11 by 3 months post-op in all of the studied eyes.
We demonstrate the ability to quantitatively measure the Goldmann visual field area and use this measurement to follow the trends in visual changes post-operatively. Our initial analysis suggests that there is a trend toward increased visual field area following orbital decompression. These findings provide impetus to analyze additional eyes, which could provide further insight into the post-operative prognosis and trajectory of changes after orbital decompression.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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