The Columbia Thyroid Eye Disease-Compressive Optic Neuropathy Diagnostic Formula

Alison B. Callahan, Ashley A. Campbell, Susel Oropesa, Aryeh Baraban, Michael Kazim

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Purpose: Diagnosing thyroid eye disease–compressive optic neuropathy (TED–CON) is challenging, particularly in cases lacking a relative afferent pupillary defect. Large case series of TED–CON patients and accessible diagnostic tools are lacking in the current literature. This study aims to create a mathematical formula that accurately predicts the presence or absence of CON based on the most salient clinical measures of optic neuropathy. Methods: A retrospective case series compares 108 patients (216 orbits) with either unilateral or bilateral TED–CON and 41 age-matched patients (82 orbits) with noncompressive TED. Utilizing clinical variables assessing optic nerve function and/ or risk of compressive disease, and with the aid of generalized linear regression modeling, the authors create a mathematical formula that weighs the relative contribution of each clinical variable in the overall prediction of CON. Results: Data from 213 orbits in 110 patients derived the formula: y = −0.69 + 2.58 × (afferent pupillary defect) − 0.31 × (summed limitation of ductions) − 0.2 × (mean deviation on Humphrey visual field testing) − 0.02 × (% color plates). This accurately predicted the presence of CON (y > 0) versus non-CON (y < 0) in 82% of cases with 83% sensitivity and 81% specificity. When there was no relative afferent pupillary defect, which was the case in 63% of CON orbits, the formula correctly predicted CON in 78% of orbits with 73% sensitivity and 83% specificity. Conclusions: The authors developed a mathematical formula, the Columbia TED-CON Diagnostic Formula (CTD Formula), that can help guide clinicians in accurately diagnosing TED–CON, particularly in the presence of bilateral disease and when no relative afferent pupillary defect is present.

Original languageEnglish (US)
Pages (from-to)S68-S71
JournalOphthalmic plastic and reconstructive surgery
Issue number4
StatePublished - Jul 1 2018

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology


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