Multimodal optical coherence tomography and angiography and serologic markers for accurate early diagnosis of dysthyroid optic neuropathy.

OBJECTIVE

To assess the value of optical coherence tomography (OCT) and OCT angiography (OCTA) for the early diagnosis of dysthyroid optic neuropathy (DON) in patients with thyroid-associated orbitopathy (TAO).

METHODS

This retrospective study (2022-2024) included 52 TAO eyes (22 DON, 30 non-DON) and 52 healthy controls. OCT/OCTA scans evaluated structural features (ganglion cell complex, peripapillary retinal nerve fiber layer, Bruch's membrane opening-minimum rim width [BMO-MRW]) and vascular features (superficial retinal capillary plexus [SRCP] density, choroidal capillary vascular density, foveal avascular zone [FAZ] area). Contrast sensitivity function (CSF), thyroid peroxidase antibody (TPOAb) status, and glutamate levels were also analyzed. Multivariate logistic regression identified risk factors, and receiver operating characteristic curves evaluated diagnostic performance.

RESULTS

Most structural OCT features showed no significant differences, except CSF, which was significantly reduced in DON eyes (P < 0.001). Vascular features such as SRCP density and choroidal capillary density decreased progressively in DON, while FAZ area was significantly larger (all P < 0.001). TPOAb positivity and glutamate levels were highest in the DON group (P < 0.001). Multivariate analysis identified SRCP density, FAZ area, TPOAb positivity, and glutamate concentration as independent risk factors for DON. A combined model of BMO-MRW and subfoveal choroidal thickness achieved the highest diagnostic accuracy (AUC = 0.940, sensitivity = 88.0%, specificity = 90.0%).

CONCLUSIONS

Multimodal imaging combining OCT and OCTA features improves the sensitivity and specificity of early DON diagnosis, offering a reliable, noninvasive screening approach for clinical practice.