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Cohort studyIndian journal of endocrinology and metabolism · 2026

Dysthyroid Optic Neuropathy in Graves' Orbitopathy: Insights from a Single Centre and Limitations of the Radiological Indices.

Khushboo Agarwal, Alen Antony Joy, Madhavi Veerappan … Nihal Thomas

OphthalmologyCohort study

A Barrett's index cutoff of 58% helped flag optic nerve damage in Graves' orbitopathy.

Dysthyroid Optic Neuropathy in Graves' Orbitopathy: Insights from a Single Centre and Limitations of the Radiological Indices.

Khushboo Agarwal … Nihal Thomas

Indian journal of endocrinology and metabolism · 2026

Background

Close to 50% of patients with Graves' disease have associated ocular involvement, of which dysthyroid optic neuropathy (dysthyroid optic neuropathy) is prevalent in 3-5% of patients.

Purpose

The purpose of this study was to assess the efficacy of various radiological indices (Barrett's index, Nugent index) in predicting dysthyroid optic neuropathy and treatment response or relapse in this population.

Methods

This was a retrospective study that included patients presenting with clinically active Graves' orbitopathy (GO) between January 2005 and June 2021 to our hospital.

n = 29 patients

Results

This imaging measure had only moderate accuracy for detecting optic nerve damage (60% sensitivity, 68.8% specificity).

60%

Sensitivity

68.8%

Specificity

More results

A higher Barrett's index was associated with dysthyroid optic neuropathy (61.4% vs 51.1%, P = 0.03), lower glucocorticoid responsiveness (63.7% vs 54.2%, P = 0.043), and the need for surgical intervention (62.85% vs 49.3%, P = 0.001).

More results

Nugent index ≥1 was significantly associated with sight-threatening GO (48.2% vs 22.2%, P = 0.02) and higher glucocorticoid requirements (54.8% vs 23.8%, P = 0.04).

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Conclusion · 1 of 2

This is the first comprehensive assessment of patients with GO among Indians with active disease. The Barrett's index threshold was defined in our population to facilitate objective early identification of dysthyroid optic neuropathy.

Conclusion · 2 of 2

This index shows promise for early diagnostic sub-categorisation in dysthyroid optic neuropathy among Indians; however, its low sensitivity limits its widespread use.

Post

Dysthyroid Optic Neuropathy in Graves' Orbitopathy: Insights from a Single Centre and Limitations of the Radiological Indices.

A Barrett's index cutoff of 58% helped flag optic nerve damage in Graves' orbitopathy.

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