Acta Ophthalmologica 2015
both eyes, and the refractive error was –1.0 D OD and –0.25 D OS. Her IOP was 14 mmHg OD and 15 mmHg OS. Ophthalmoscopy revealed bilateral neuroretinal rim narrowing at the optic disc margin, inferior retinal nerve fibre layer (RNFL) defect and peripapillary retinoschisis without a posterior vitreous detachment in the right eye with normal open anterior chamber angle (Fig. 1). Fluorescein angiography showed no leakage or any signs of an optic disc pit. Optical coherence tomography (OCT, OCT3-STRATUS, Carl Zeiss Meditec) revealed peripapillary retinoschisis and retinal detachment. Humphrey field analyzer (Humphrey- Zeiss System) showed a superior Bjerrum scotoma corresponding to the inferior RNFL defect in both eyes. She was followed without any treatment because of her good vision. The headaches and periorbital pain disappeared after 1 month. She noticed that the paracentral scotoma had moved gradually towards the central visual field, and the peripapillary retinoschisis turned to macular retinoschisis at 15 months but she maintained good vision of 20/20. The macular retinoschisis completely resolved after 3 years without any recurrence for 2 years. Vision was maintained at 20/20 without a central scotoma. The IOP remained within the normal range without any topical medication and no progression of the visual field defect was detected. Spectral domain OCT (Cirrus-HD-OCT, Carl Zeiss Meditec) showed a resolution of the macular retinoschisis with partially detachment of the posterior vitreous cortex. The optic disc cup was deeper corresponding to the resolution of the peripapillary retinoschisis and schisis within the optic disc. Kahook et al. (2007) described two cases of peripapillary retinoschisis associated with increased IOP and angle-closure glaucoma. An acute elevation of the IOP can lead to structural defects in the optic nerve head and peripapillary retinoschisis as seen in cases of optic disc pit maculopathy. Zumbro et al. (2007) reported that vitreous surgery can resolve a retinoschisis associated with an enlarged optic disc cup. They reported that vitreous traction may have played a role in the development of the macular retinoschisis and foveal detachment. Zhao & Li (2011) described a case of
e318
macular retinoschisis that developed in an eye with normal tension glaucoma. They also suggested that vitreous traction was the cause of the retinoschisis near the RNFL defect, and the foveal detachment developed by the seeping of fluid through the intraretinal spaces. The IOP was normal as in our patient, and vitreous traction probably caused the peripapillary and macular retinoschisis that resolved spontaneously when the posterior vitreous cortex was partially detached. Hwang et al. (2014) described a case of peripapillary retinoschisis within the retinal nerve fibre, ganglion cell and inner plexiform layers detected in the OCT images of 19 glaucomatous eyes. However, none of the eyes developed macular retinoschisis, and the peripapillary retinoschisis resolved without any treatment. Our patient developed symptomatic peripapillary retinoschisis and retinal detachment which expanded to macular retinoschisis. Thus, peripapillary retinoschisis associated with glaucomatous optic neuropathy can progress to macular retinoschisis which can resolve spontaneously by a partial vitreous detachment.
References Hollander DA, Barricks ME, Duncan JL & Irvine AR (2005): Macular schisis detachment associated with angle-closure glaucoma. Arch Ophthalmol 123: 270–272. Hwang YH, Kim YY, Kim HK & Sohn YH (2014): Effect of peripapillary retinoschisis on retinal nerve fibre layer thickness measurement in glaucomatous eyes. Br J Ophthalmol 98: 669–674. Kahook MY, Noecker RJ, Ishikawa H et al. (2007): Peripapillary schisis in glaucoma patients with narrow angles and increased intraocular pressure. Am J Ophthalmol 143: 697–699. Zhao M & Li X (2011): Macular retinoschisis associated with normal tension glaucoma. Graefes Arch Clin Exp Ophthalmol 249: 1255–1258. Zumbro DS, Jampol LM, Folk JC, Olivier MM & Anderson-Nelson S (2007): Macular schisis and detachment associated with presumed acquired enlarged optic nerve head cups. Am J Ophthalmol 144: 70–74.
Correspondence: Makoto Inoue, MD Kyorin Eye Center Kyorin University, School of Medicine 6-20-2 Shinkawa
Mitaka, Tokyo 181-8611, Japan Tel: +81 422 475511, ext.2606 Fax: +81 422 469309 Email: [email protected]
Metamorphopsia and interocular suppression in monocular and binocular maculopathy Emily Wiecek,1,2,3 Kameran Lashkari,1,2 Steven C. Dakin3,4,5 and Peter Bex1,2,6 1
Schepens Eye Research Institute/ Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; 2 Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; 3Institute of Ophthalmology, University College London, London, UK; 4National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, London, UK; 5 Department of Optometry & Vision Science, University of Auckland, New Zealand; 6Department of Psychology, Northeastern University, Boston, Massachusetts, USA doi: 10.1111/aos.12559
Editor,
M
etamorphopsia is a key symptom of macular disease, particularly age-related macular degeneration (AMD) (De Jong 2006), that is often measured with Amsler grids at home and in the clinic, even though the test lacks both sensitivity and specificity (Schuchard 1993; Crossland & Rubin 2007). We address issues of monocular viewing and fixation compliance with a computerized version of the Amsler grid and binocular eyetracking. Control of monocular viewing and compliant fixation enabled accurate quantification of the area and location of metamorphopsia in each eye. An eight-item questionnaire was administered to assess metamorphopsia patient reported outcomes (Alster et al. 2005; Arimura et al. 2011), and we measured interocular suppression with a dichoptic task with stereo shutter glasses. All participants were recruited with the criterion of no reported foveal vision loss and binoc-
Acta Ophthalmologica 2015
(A) (B)
(C)
Fig. 1. (A) The response distributions across all participants for the eight questions with four similar response categories. (B) The average total questionnaire score for each diagnosis tested, including wet age-related macular degeneration (AMD), dry AMD, epiretinal membrane (ERM), macular oedema, macular scar, central serous retinopathy (CSR) and retinal detachment. Red dots represent outliers. (C) Left panel shows box plots for the difference in questionnaire score between patients who experienced binocular foveal distortion and those who did not. (C) Right panel shows a similar comparison for patients who experienced suppression and those who did not. The black asterisks represent the mean of each distribution, and the horizontal black lines represent the medians. Outliers are displayed as black points.
ular calibration was used to track either eye monocularly. Those not accurately tracked were excluded from the study. Of the 74 macular disease patients who viewed the Amsler grid monocularly with each eye, 95% (70/74) experienced distortion in at least one eye, and 27% (20/74) experienced distortion in both eyes. Of the 34% (25/74) of participants diagnosed with binocular macular pathology, 80% (20/25) perceived distortions in each eye. Despite this high prevalence, most patients report no impact of distortion on the metamorphopsia questionnaire (Fig. 1A), and the overall area of the Amsler grid affected by distortion was not correlated with the score. There were no differences between total metamorphopsia score across the nine disease groups (see Fig. 1B). Participants with foveal distortion in both eyes (25%, 18/74) had a significantly higher score (3.7) than those who experienced metamorphopsia in only one eye (1.9), (p = 0.04, nonparametric Mann–Whitney U-test, Fig. 1C left). We also found a significant correlation with LogMAR acuity in the
affected eye and the total metamorphopsia questionnaire score (r = 0.189, p = 0.031). In a post hoc analysis, an assessment to detect interocular suppression was administered to 49 of 74 participants who reported distortion in only one eye with our computerized Amsler grid. A nonoverlapping circle and cross were presented to each eye dichoptically with stereo shutter glasses. Suppression was classified when observers were unable to perceive both targets simultaneously even when the unseen target was moved. We found robust suppression of the affected eye in 59% (29 of 49) of monocular participants, and those who did not suppress scored higher (2.5) on the metamorphopsia questionnaire than those who did suppress (2.2), but not significantly so (p = 0.3, Fig. 1C right). Thus, distortions must be foveal and binocular to be noticeable in everyday life since monocular distortions are often suppressed by a less impaired eye. This lack of awareness may be critical when distortion is used as a screening and progression-monitoring
tool or as a postoperative outcome measure (Jensen 1998; Wang et al. 2005; Wittich et al. 2005), especially given the importance of self-referral for AMD. Our findings should warn patients and clinicians against a false sense of security when the progression of monocular vision pathology seems stable when assessed with Amsler grids or patients reported outcomes that may be (self-) administered binocularly. In these cases, the patient may not be aware of spatial distortion in everyday activities, and hence fail to report pathological vision impairment to a clinician.
References Alster Y, Bressler NM, Bressler SB et al. (2005): Preferential Hyperacuity Perimeter (PreView PHP) for detecting choroidal neovascularization study. Ophthalmology 112: 1758–1765. Arimura E, Matsumoto C, Nomoto H, Hashimoto S, Takada S, Okuyama S & Shimomura Y (2011): Correlations between M-CHARTS and PHP findings and subjective perception of metamorphopsia in
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Acta Ophthalmologica 2015
patients with macular diseases. Invest Ophthalmol Vis Sci 52: 128–135. Crossland M & Rubin G (2007): The Amsler chart: absence of evidence is not evidence of absence. Br J Ophthalmol 91: 391–393. De Jong PTVM (2006): Age-related macular degeneration. N Engl J Med 355: 1474–1485. Jensen OLM (1998): Objective assessment of photoreceptor displacement and metamorphopsia: a study of macular holes. Arch Ophthalmol 116: 1303–1306. Schuchard RA (1993): Validity and interpretation of Amsler grid reports. Arch Ophthalmol 111: 776–780. Wang Y, Li S, Zhu M, Chen S, Liu Y, Men X, Gillies M & Larsson J (2005): Metamorphopsia after successful retinal detachment surgery: an optical coherence tomography study. Acta Ophthalmol Scand 83: 168–171. Wittich W, Overbury O, Kapusta MA & Faubert J (2005): Visual function assessment and metamorphopsia after macular hole surgery*,†. Ophthalmic Physiol Opt 25: 534–542.
Correspondence: Emily Wiecek 125 Nightingale, 360 Huntington Ave., Boston, Massachusetts 02115, USA Tel.: +1 716 491 0538 Fax: +1 617 373 8714 Email: [email protected]
Corneal biomechanical properties in patients with Graves’ Disease Georgios D. Panos,1 Xuefei Song,2 Farhad Hafezi,1 Berthold Seitz,2 Achim Langenbucher2 and Zisis Gatzioufas1,2 1 Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland2Department of Ophthalmology, Saarland University Hospital, Homburg, Germany
keratopathy, diplopia and compressive optic neuropathy (Menconi et al. 2014). On the other hand, there is evidence that hormonal disorders can affect corneal biomechanical properties (Gatzioufas et al. 2014; Ozkok et al. 2014). In this study, we aimed to investigate the effect of thyroid status on central corneal thickness (CCT) and corneal biomechanics in patients with GD. This prospective observational study included patients with newly diagnosed GD without prior treatment. Exclusion criteria were as follows: Graves ophthalmopathy > Class 2 according to NOSPECS classification, the existence of underlying corneal disease, age7. All non-contact corneal measurements were made before any contact measurements. All patients were examined by the same physician.
Table 1. Demographical data, characteristics and detailed status of corneal biomechanical properties and CCT of the GD and control group.
doi: 10.1111/aos.12563
Editor, n Graves’ disease (GD), various organ systems are affected. Apart from well-known general symptoms, including nervousness, palpitations, sweating, heat intolerance, weight loss, fatigability, dyspnoea, fatigue, oligomenorrhoea, increased appetite and diarrhoea, there are also ocular manifestations related to Graves’ orbitopathy such as exposition
I
e320
All parameters used in the study were expressed as the mean standard deviation (SD). Normality of the data was tested with the Kolmogorov– Smirnov test, and comparison of quantitative characteristics was performed using the Student’s t-test. Furthermore, Pearson’s correlation coefficient was used to analyse potential statistical associations. p values below 0.05 were considered statistically significant. Statistical analysis was performed using MEDCALC ver.10.2 (MedCalcâ, Ostend, Belgium). Forty-nine eyes of 49 patients were included in the study (GD group, n = 24 eyes of 24 patients, control group, n = 25 eyes of 25 patients). The mean age was 41.96 8.16 years for the patients in GD group and 41.44 6.56 years for the control group (p = 0 .81). Female/male distribution was not different between the two groups (21/03 in GD group and 20/05 in control group (McNemar test, p = 0.69). Demographical characteristics of both groups are summarized in Table 1. The mean CCT was 549.58 36.44 lm in the GD group and 536.12 42.47 lm in the control group. No significant difference was observed (p = 0.24) between the two groups. Mean CRF was 10.97 1.94 mmHg in the GD group and 8.91 1.80 mmHg in the control group. Significant difference was observed (p = 0.0003) between the two groups. Mean CH was 10.77 1.88 mmHg in the GD group and 7.79 2.33 mmHg in the control group. Significant difference was observed (p < 0.0001) between the two groups. Regarding the IOP values (IOPcc, IOPg, IOP GAT), significant difference was observed between study and
MPatients/Eyes No. of patients No. of eyes Gender Age (mean SD) Race CCT (lm) CRF (mmHg) CH (mmHg) IOPcc (mmHg) IOPg (mmHg) IOP GAT (mmHg)
Graves’ disease group
Control group
24 24 21 ♀, 3 ♂ 41.96 8.16 All Caucasian 549.58 36.44 10.97 1.94 10.77 1.88 16.3 1.7 15.7 1.6 15.1 1.7
25 25 20 ♀, 5 ♂ 41.44 6.56 All Caucasian 536.12 42.47 8.91 1.80 7.79 2.33 15.0 2.1 14.4 2.1 13.8 2.2
p
0.69 0.81 0.24 0.0003
both eyes, and the refractive error was –1.0 D OD and –0.25 D OS. Her IOP was 14 mmHg OD and 15 mmHg OS. Ophthalmoscopy revealed bilateral neuroretinal rim narrowing at the optic disc margin, inferior retinal nerve fibre layer (RNFL) defect and peripapillary retinoschisis without a posterior vitreous detachment in the right eye with normal open anterior chamber angle (Fig. 1). Fluorescein angiography showed no leakage or any signs of an optic disc pit. Optical coherence tomography (OCT, OCT3-STRATUS, Carl Zeiss Meditec) revealed peripapillary retinoschisis and retinal detachment. Humphrey field analyzer (Humphrey- Zeiss System) showed a superior Bjerrum scotoma corresponding to the inferior RNFL defect in both eyes. She was followed without any treatment because of her good vision. The headaches and periorbital pain disappeared after 1 month. She noticed that the paracentral scotoma had moved gradually towards the central visual field, and the peripapillary retinoschisis turned to macular retinoschisis at 15 months but she maintained good vision of 20/20. The macular retinoschisis completely resolved after 3 years without any recurrence for 2 years. Vision was maintained at 20/20 without a central scotoma. The IOP remained within the normal range without any topical medication and no progression of the visual field defect was detected. Spectral domain OCT (Cirrus-HD-OCT, Carl Zeiss Meditec) showed a resolution of the macular retinoschisis with partially detachment of the posterior vitreous cortex. The optic disc cup was deeper corresponding to the resolution of the peripapillary retinoschisis and schisis within the optic disc. Kahook et al. (2007) described two cases of peripapillary retinoschisis associated with increased IOP and angle-closure glaucoma. An acute elevation of the IOP can lead to structural defects in the optic nerve head and peripapillary retinoschisis as seen in cases of optic disc pit maculopathy. Zumbro et al. (2007) reported that vitreous surgery can resolve a retinoschisis associated with an enlarged optic disc cup. They reported that vitreous traction may have played a role in the development of the macular retinoschisis and foveal detachment. Zhao & Li (2011) described a case of
e318
macular retinoschisis that developed in an eye with normal tension glaucoma. They also suggested that vitreous traction was the cause of the retinoschisis near the RNFL defect, and the foveal detachment developed by the seeping of fluid through the intraretinal spaces. The IOP was normal as in our patient, and vitreous traction probably caused the peripapillary and macular retinoschisis that resolved spontaneously when the posterior vitreous cortex was partially detached. Hwang et al. (2014) described a case of peripapillary retinoschisis within the retinal nerve fibre, ganglion cell and inner plexiform layers detected in the OCT images of 19 glaucomatous eyes. However, none of the eyes developed macular retinoschisis, and the peripapillary retinoschisis resolved without any treatment. Our patient developed symptomatic peripapillary retinoschisis and retinal detachment which expanded to macular retinoschisis. Thus, peripapillary retinoschisis associated with glaucomatous optic neuropathy can progress to macular retinoschisis which can resolve spontaneously by a partial vitreous detachment.
References Hollander DA, Barricks ME, Duncan JL & Irvine AR (2005): Macular schisis detachment associated with angle-closure glaucoma. Arch Ophthalmol 123: 270–272. Hwang YH, Kim YY, Kim HK & Sohn YH (2014): Effect of peripapillary retinoschisis on retinal nerve fibre layer thickness measurement in glaucomatous eyes. Br J Ophthalmol 98: 669–674. Kahook MY, Noecker RJ, Ishikawa H et al. (2007): Peripapillary schisis in glaucoma patients with narrow angles and increased intraocular pressure. Am J Ophthalmol 143: 697–699. Zhao M & Li X (2011): Macular retinoschisis associated with normal tension glaucoma. Graefes Arch Clin Exp Ophthalmol 249: 1255–1258. Zumbro DS, Jampol LM, Folk JC, Olivier MM & Anderson-Nelson S (2007): Macular schisis and detachment associated with presumed acquired enlarged optic nerve head cups. Am J Ophthalmol 144: 70–74.
Correspondence: Makoto Inoue, MD Kyorin Eye Center Kyorin University, School of Medicine 6-20-2 Shinkawa
Mitaka, Tokyo 181-8611, Japan Tel: +81 422 475511, ext.2606 Fax: +81 422 469309 Email: [email protected]
Metamorphopsia and interocular suppression in monocular and binocular maculopathy Emily Wiecek,1,2,3 Kameran Lashkari,1,2 Steven C. Dakin3,4,5 and Peter Bex1,2,6 1
Schepens Eye Research Institute/ Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; 2 Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; 3Institute of Ophthalmology, University College London, London, UK; 4National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, London, UK; 5 Department of Optometry & Vision Science, University of Auckland, New Zealand; 6Department of Psychology, Northeastern University, Boston, Massachusetts, USA doi: 10.1111/aos.12559
Editor,
M
etamorphopsia is a key symptom of macular disease, particularly age-related macular degeneration (AMD) (De Jong 2006), that is often measured with Amsler grids at home and in the clinic, even though the test lacks both sensitivity and specificity (Schuchard 1993; Crossland & Rubin 2007). We address issues of monocular viewing and fixation compliance with a computerized version of the Amsler grid and binocular eyetracking. Control of monocular viewing and compliant fixation enabled accurate quantification of the area and location of metamorphopsia in each eye. An eight-item questionnaire was administered to assess metamorphopsia patient reported outcomes (Alster et al. 2005; Arimura et al. 2011), and we measured interocular suppression with a dichoptic task with stereo shutter glasses. All participants were recruited with the criterion of no reported foveal vision loss and binoc-
Acta Ophthalmologica 2015
(A) (B)
(C)
Fig. 1. (A) The response distributions across all participants for the eight questions with four similar response categories. (B) The average total questionnaire score for each diagnosis tested, including wet age-related macular degeneration (AMD), dry AMD, epiretinal membrane (ERM), macular oedema, macular scar, central serous retinopathy (CSR) and retinal detachment. Red dots represent outliers. (C) Left panel shows box plots for the difference in questionnaire score between patients who experienced binocular foveal distortion and those who did not. (C) Right panel shows a similar comparison for patients who experienced suppression and those who did not. The black asterisks represent the mean of each distribution, and the horizontal black lines represent the medians. Outliers are displayed as black points.
ular calibration was used to track either eye monocularly. Those not accurately tracked were excluded from the study. Of the 74 macular disease patients who viewed the Amsler grid monocularly with each eye, 95% (70/74) experienced distortion in at least one eye, and 27% (20/74) experienced distortion in both eyes. Of the 34% (25/74) of participants diagnosed with binocular macular pathology, 80% (20/25) perceived distortions in each eye. Despite this high prevalence, most patients report no impact of distortion on the metamorphopsia questionnaire (Fig. 1A), and the overall area of the Amsler grid affected by distortion was not correlated with the score. There were no differences between total metamorphopsia score across the nine disease groups (see Fig. 1B). Participants with foveal distortion in both eyes (25%, 18/74) had a significantly higher score (3.7) than those who experienced metamorphopsia in only one eye (1.9), (p = 0.04, nonparametric Mann–Whitney U-test, Fig. 1C left). We also found a significant correlation with LogMAR acuity in the
affected eye and the total metamorphopsia questionnaire score (r = 0.189, p = 0.031). In a post hoc analysis, an assessment to detect interocular suppression was administered to 49 of 74 participants who reported distortion in only one eye with our computerized Amsler grid. A nonoverlapping circle and cross were presented to each eye dichoptically with stereo shutter glasses. Suppression was classified when observers were unable to perceive both targets simultaneously even when the unseen target was moved. We found robust suppression of the affected eye in 59% (29 of 49) of monocular participants, and those who did not suppress scored higher (2.5) on the metamorphopsia questionnaire than those who did suppress (2.2), but not significantly so (p = 0.3, Fig. 1C right). Thus, distortions must be foveal and binocular to be noticeable in everyday life since monocular distortions are often suppressed by a less impaired eye. This lack of awareness may be critical when distortion is used as a screening and progression-monitoring
tool or as a postoperative outcome measure (Jensen 1998; Wang et al. 2005; Wittich et al. 2005), especially given the importance of self-referral for AMD. Our findings should warn patients and clinicians against a false sense of security when the progression of monocular vision pathology seems stable when assessed with Amsler grids or patients reported outcomes that may be (self-) administered binocularly. In these cases, the patient may not be aware of spatial distortion in everyday activities, and hence fail to report pathological vision impairment to a clinician.
References Alster Y, Bressler NM, Bressler SB et al. (2005): Preferential Hyperacuity Perimeter (PreView PHP) for detecting choroidal neovascularization study. Ophthalmology 112: 1758–1765. Arimura E, Matsumoto C, Nomoto H, Hashimoto S, Takada S, Okuyama S & Shimomura Y (2011): Correlations between M-CHARTS and PHP findings and subjective perception of metamorphopsia in
e319
Acta Ophthalmologica 2015
patients with macular diseases. Invest Ophthalmol Vis Sci 52: 128–135. Crossland M & Rubin G (2007): The Amsler chart: absence of evidence is not evidence of absence. Br J Ophthalmol 91: 391–393. De Jong PTVM (2006): Age-related macular degeneration. N Engl J Med 355: 1474–1485. Jensen OLM (1998): Objective assessment of photoreceptor displacement and metamorphopsia: a study of macular holes. Arch Ophthalmol 116: 1303–1306. Schuchard RA (1993): Validity and interpretation of Amsler grid reports. Arch Ophthalmol 111: 776–780. Wang Y, Li S, Zhu M, Chen S, Liu Y, Men X, Gillies M & Larsson J (2005): Metamorphopsia after successful retinal detachment surgery: an optical coherence tomography study. Acta Ophthalmol Scand 83: 168–171. Wittich W, Overbury O, Kapusta MA & Faubert J (2005): Visual function assessment and metamorphopsia after macular hole surgery*,†. Ophthalmic Physiol Opt 25: 534–542.
Correspondence: Emily Wiecek 125 Nightingale, 360 Huntington Ave., Boston, Massachusetts 02115, USA Tel.: +1 716 491 0538 Fax: +1 617 373 8714 Email: [email protected]
Corneal biomechanical properties in patients with Graves’ Disease Georgios D. Panos,1 Xuefei Song,2 Farhad Hafezi,1 Berthold Seitz,2 Achim Langenbucher2 and Zisis Gatzioufas1,2 1 Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland2Department of Ophthalmology, Saarland University Hospital, Homburg, Germany
keratopathy, diplopia and compressive optic neuropathy (Menconi et al. 2014). On the other hand, there is evidence that hormonal disorders can affect corneal biomechanical properties (Gatzioufas et al. 2014; Ozkok et al. 2014). In this study, we aimed to investigate the effect of thyroid status on central corneal thickness (CCT) and corneal biomechanics in patients with GD. This prospective observational study included patients with newly diagnosed GD without prior treatment. Exclusion criteria were as follows: Graves ophthalmopathy > Class 2 according to NOSPECS classification, the existence of underlying corneal disease, age7. All non-contact corneal measurements were made before any contact measurements. All patients were examined by the same physician.
Table 1. Demographical data, characteristics and detailed status of corneal biomechanical properties and CCT of the GD and control group.
doi: 10.1111/aos.12563
Editor, n Graves’ disease (GD), various organ systems are affected. Apart from well-known general symptoms, including nervousness, palpitations, sweating, heat intolerance, weight loss, fatigability, dyspnoea, fatigue, oligomenorrhoea, increased appetite and diarrhoea, there are also ocular manifestations related to Graves’ orbitopathy such as exposition
I
e320
All parameters used in the study were expressed as the mean standard deviation (SD). Normality of the data was tested with the Kolmogorov– Smirnov test, and comparison of quantitative characteristics was performed using the Student’s t-test. Furthermore, Pearson’s correlation coefficient was used to analyse potential statistical associations. p values below 0.05 were considered statistically significant. Statistical analysis was performed using MEDCALC ver.10.2 (MedCalcâ, Ostend, Belgium). Forty-nine eyes of 49 patients were included in the study (GD group, n = 24 eyes of 24 patients, control group, n = 25 eyes of 25 patients). The mean age was 41.96 8.16 years for the patients in GD group and 41.44 6.56 years for the control group (p = 0 .81). Female/male distribution was not different between the two groups (21/03 in GD group and 20/05 in control group (McNemar test, p = 0.69). Demographical characteristics of both groups are summarized in Table 1. The mean CCT was 549.58 36.44 lm in the GD group and 536.12 42.47 lm in the control group. No significant difference was observed (p = 0.24) between the two groups. Mean CRF was 10.97 1.94 mmHg in the GD group and 8.91 1.80 mmHg in the control group. Significant difference was observed (p = 0.0003) between the two groups. Mean CH was 10.77 1.88 mmHg in the GD group and 7.79 2.33 mmHg in the control group. Significant difference was observed (p < 0.0001) between the two groups. Regarding the IOP values (IOPcc, IOPg, IOP GAT), significant difference was observed between study and
MPatients/Eyes No. of patients No. of eyes Gender Age (mean SD) Race CCT (lm) CRF (mmHg) CH (mmHg) IOPcc (mmHg) IOPg (mmHg) IOP GAT (mmHg)
Graves’ disease group
Control group
24 24 21 ♀, 3 ♂ 41.96 8.16 All Caucasian 549.58 36.44 10.97 1.94 10.77 1.88 16.3 1.7 15.7 1.6 15.1 1.7
25 25 20 ♀, 5 ♂ 41.44 6.56 All Caucasian 536.12 42.47 8.91 1.80 7.79 2.33 15.0 2.1 14.4 2.1 13.8 2.2
p
0.69 0.81 0.24 0.0003
