Evaluation of Ocular Versions in Graves' Orbitopathy: Correlation between the Qualitative Clinical Method and the Quantitative Photographic Method

Cristiane de Almeida Leite, Thaís de Sousa Pereira, Jeane Chiang, Allan C Pieroni Gonçalves, Mário L R Monteiro, Cristiane de Almeida Leite, Thaís de Sousa Pereira, Jeane Chiang, Allan C Pieroni Gonçalves, Mário L R Monteiro

Abstract

Purpose: To assess the agreement between the qualitative clinical method and the quantitative photographic method of evaluating normal and abnormal ocular versions in patients with inactive Graves' orbitopathy (GO).

Methods: Forty-two patients with inactive GO had their ocular versions evaluated clinically according to three categories: normal, moderate alterations (-1 or -2 hypofunction), and severe alterations (-3 or -4 hypofunction). The subjects were photographed in the 9 positions of gaze, and the extent (mm) of eye movement in each position was estimated using Photoshop® and ImageJ and converted into degrees with a well-established method. The agreement between the two methods (qualitative vs. quantitative) for classifying ocular versions as normal or abnormal was assessed.

Results: The mean quantitative measurements of versions were significantly different for each clinical category (normal, moderate alterations, and severe alterations) in the following five positions: abduction, adduction, elevation in abduction, elevation, and elevation in adduction (p < 0.001). No such pattern was observed for the three infraversion positions (depression in abduction, p=0.573; depression, p=0.468; depression in adduction, p=0.268).

Conclusion: The agreement was strong between the quantitative photographic method and the qualitative clinical method of classifying ocular versions, especially in lateral and supraversions, which are typically affected in GO. Digital photography is recommended for the assessment of ocular versions due to its practicality, suitability for telemedicine applications, and ease of monitoring during follow-up. This trial is registered with NCT03278964.

Conflict of interest statement

None of the authors have any conflicts of interest to declare.

Copyright © 2020 Cristiane de Almeida Leite et al.

Figures

Figure 1
Figure 1
Photographs of the 9 cardinal positions of gaze.
Figure 2
Figure 2
(a) Juxtaposition of semitransparent images of primary gaze and dextroversion (Photoshop) for quantitative version evaluation. (b) Evaluation of dextroversion. Right eye: in abduction, the distance between the medial limbi of the juxtaposed photos is measured. Left eye: in adduction, the distance between the lateral limbi is measured.
Figure 3
Figure 3
Mean degrees of versions in the cardinal positions of gaze in Graves' orbitopathy patients with clinically normal versions (based on Lim and colleagues) [11].
Figure 4
Figure 4
Graphic representation of the agreement between qualitative clinical categories and quantitative photographic measurements of version in the 8 secondary and tertiary positions of gaze in 42 patients with GO.

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