LONG-TERM FOLLOW-UP OF GRAVES OPHTHALMOPATHY IN AN INCIDENCE COHORT

Purpose: To provide long-term follow-up data on patients with Graves o phthalmopathy in an incidence cohort of 120 patients. Methods: Data we re obtained from a comprehensive review of each patient's community me dical record, a follow-up survey, or both. Results: The median interva l between the initial ophthalmic examination and most recent follow-up was 9.8 years (range, 64 days to 17.4 years). Follow-up of more than 5 years was available for 96 patients (80.0%), whereas follow-up excee ding 10 years was achieved for 59 patients (49.2%). Persistent visual loss from optic neuropathy occurred in two eyes, with final visual acu ities of 20/30 and 20/60, respectively. None of the patients reported deterioration of vision attributable to Graves ophthalmopathy in the i nterval since their last ophthalmic examination at the authors' instit ution. Two patients (2.2%) had constant diplopia, but it was correctab le with spectacles (prisms) in each case. Nearly one third of responde nts had had ocular discomfort during the preceding 4 weeks; the most f requent cause in 72% of patients was dry eyes. Among the respondents t o the survey, 60.5% believed that the appearance of their eyes had not returned to what it had been before the development of thyroid diseas e, 51.6% thought that their eyes appeared abnormal, and 37.9% were dis satisfied with the appearance of their eyes. Conclusions. Although wit h treatment few patients have long-term functional impairment from Gra ves ophthalmopathy, more than one third of patients are dissatisfied w ith their ultimate appearance. The psychologic, aesthetic, economic, a nd social sequelae of the disorder require further definition by forma l outcomes studies.