Correlation Between Pupillary Examination And Thyroid Associated Ophthalmopathy Visual Injury

Purpose: The differences of pupil light reflex function between thyroid associated ophthalmopathy(TAO)patients and normal people are compared.The correlation between pupil function and the severity of thyroid associated ophthalmopathy,visual acuity,pattern visual evoked potential(PVEP),visual field and retinal nerve fiber layer(RNFL)thickness are explored.Methods: In this study,72 patients(144 eyes)with thyroid associated ophthalmopathy(TAO)are selected from Shantou International Eye Center from May2021 to March 2022,with an average age of 48.2 ±11.3 years,including 56 eyes in mild TAO group,71 eyes in moderate to severe TAO group,17 eyes in extremely severe TAO group,and 22 cases(44 eyes)in control group with an average age of 46.6±14.6years.Visual acuity,pupil function,PVEP,visual field and RNFL thickness were examined.Pupil function includes amplitude score,latency score,pupil size,contraction amplitude,amplitude response,contraction latency,peak contraction latency,peak contraction velocity and peak relaxation velocity.The differences of direct light reflex pupil function between control group and different severity TAO are compared,and the correlations between pupil function and log MAR visual acuity,P100 amplitude,P100 latency,mean deviation(MD),pattern standard deviation(PSD)and RNFL thickness are analyzed.ROC curve was used to evaluate the value of pupil function,visual field and VEP in the diagnosis of dysthyroid optic neuropathy(DON).Results: The scores of amplitude and latency of TAO in the three groups are significantly different from those in the control group.There is no significant difference in amplitude response and contraction latency between mild TAO group and control group,but the amplitude response of moderate to severe TAO group and extremely severe TAO group are different from that of control group(moderate to severe TAO group P=0.029,extremely severe TAO group P=0.035),showing a decrease in amplitude response,and there are differences in contraction latency between moderate and severe TAO group,extremely severe TAO group and control group(moderate to severe TAO group P=0.002,extremely severe TAO group P < 0.001),showing a prolongation of contraction latency.The amplitude response is positively correlated with MD value and negatively correlated with PSD value and log MAR visual acuity.The contraction latency is positively correlated with log MAR visual acuity,P100 latency and PSD value,and negatively correlated with P100 amplitude,MD value and inferior RNFL thickness.The AUC of amplitude score is 0.775,the sensitivity is 80%,the specificity was 66.7%.The AUC of latency score is 0.832,the sensitivity is 100%,the specificity was 64.3%.The AUC of amplitude response is 0.761,the sensitivity is80%,the specificity was 64.3%.The AUC of contraction latency is 0.839,the sensitivity is 90%,the specificity was 76.2%.The AUC of P100 latency is 0.859,the sensitivity is 92.3%,the specificity was 69.5%.The AUC of P100 amplitude is 0.830,the sensitivity is 69.2%,the specificity was 93.7%.The AUC of MD value is 0.848,the sensitivity is 100%,the specificity was 63.1%.The AUC of PSD value is 0.797,the sensitivity is 93.3%,the specificity was 62.2%.Conclusion: Pupil function examination can sensitively detect early visual impairment in patients with thyroid associated ophthalmopathy(TAO).Contraction latency is the most sensitive index,which is not only related to the severity of the disease,but also has good sensitivity and specificity in the diagnosis of dysthyroid optic neuropathy(DON).Pupil function examination can be used as a new method for early diagnosis of TAO visual function impairment and monitoring of TAO progression,which is helpful for early diagnosis of DON.