Skip to main content
  • Oculoplastics/Orbit

    Review of: Thyroid eye disease and its vision-threatening manifestations in the Academy IRIS Registry: 2014-2018

    Ramesh S, Zhang Q, Sharpe J, et al. American Journal of Ophthalmology, September 2023

    The IRIS Registry provides a broad array of ophthalmology patient information. In this study, investigators leveraged that information to investigate demographic factors that increase the risk of thyroid eye disease (TED).

    Study design

    This was a cross-sectional study utilizing data from patients included in the IRIS Registry during 2013–2018 who were aged 18–90 years and had at least 2 visits to an ophthalmology practice with the ICD-9/10 code for TED. The frequency of vision-threatening manifestations (VTMs) was used to measure TED severity.


    In total, 41,211 cases of TED were identified, resulting in an overall prevalence rate of 0.09%. The age group with the highest prevalence rate was age 50–54 years, and women had a 3-fold higher prevalence rate than men, regardless of age or race/ethnicity. TED was more prevalent in Black/African American and White patients than in Hispanic and Asian patients. Current and former smokers and patients with type 1 diabetes were also more likely to have TED. Eighteen percent of patients with TED had VTMs, the majority of which were attributed to corneal keratitis.


    This was a large database study that was dependent upon appropriate input of data for the validity of the results. There may also be a selection bias, as patients with mild TED may be managed by other specialties (e.g., endocrinology) and not be referred to an ophthalmology practice. Although the authors use the term “vision-threatening manifestations,” realistically, mild keratopathy is much different from compressive optic neuropathy.

    Clinical significance

    Earlier studies have investigated demographic data and associations of TED, but the information gleaned from them was limited by their small and/or homogeneous populations. The advantage of this study is its size and heterogeneity. Interestingly, many of the observations from previous studies are confirmed by this study. Findings unique to this study include the higher prevalence rate in Black patients, lower prevalence rates in Asian and Hispanic patients, and younger ages of peak prevalence for Asian, Hispanic, and Black patients.

    Financial Disclosures: Dr. Richard Allen discloses no financial relationships.