Contrast sensitivity and quality of life after orbital decompression for dysthyroid optic neuropathy

To evaluate contrast sensitivity function in patients with thyroid eye disease (TED) associated compressive optic neuropathy (CON) who achieved full recovery of conventional visual function following three-wall orbital decompression and to evaluate its impact on vision-related quality of life.

In this prospective matched case-control study, 22 TED eyes (18 TED-CON, 4 TED-non-CON) were compared to 22 healthy eyes matched on age, sex, and refraction. All TED patients had recovered 10/10 best-corrected visual acuity (BCVA), normal visual fields, and no OCT abnormalities after three-wall decompression surgery. CS was assessed using CSV-1000E, and quality of life was measured with the GO-QOL visual function subscale.

Despite normal BCVA and visual fields, TED-CON eyes showed significantly reduced CS versus controls (p < 0.01), especially at low spatial frequencies. TED-non-CON eyes also exhibited subnormal CSF, suggesting early or subclinical dysfunction. CS strongly correlated with lower GO-QOL scores (ρ =-1.00,p < 0.001), highlighting its functional relevance beyond standard tests.

TED patients with previous compressive optic neuropathy show persistent contrast sensitivity deficits despite complete recovery of visual acuity potentially reflecting irreversible or subclinical optic nerve injury. Even TED eyes without CON may exhibit subtle functional impairment. CS testing could serve as a sensitive functional marker of optic nerve stress in TED, with direct impact on patients' quality of life.