The philosophy of Graves' ophthalmopathy.
When asked what has been my philosophy of Graves' ophthalmopathy in the last 25 years in the process of caring for patients with this disease and doing clinical research, I identified in hindsight three major guiding principles. The first is a multidisciplinary approach to the disease. A close collaboration between internists and ophthalmologists and the institution of combined thyroid-eye clinics definitely improves patient care. It also creates a favorable environment for research, allowing one, for example, to do randomized clinical trials. The second is involvement of the patients themselves. This has been of great benefit. Contact with patient support groups, which are experts by experience, add a dimension not readily provided by physicians. Patients assisted in the development of a disease-specific quality-of-life questionnaire (the GO-QOL), which can be used as a separate outcome measurement of therapeutic interventions. The third is attention to the possibility of preventing the disease. Smoking has been identified as a major factor in Graves' ophthalmopathy, and there exists good circumstantial evidence that refraining from smoking has preventive value in every stage of the disease. The challenge for the future will be to identify Graves' hyperthyroid patients at high risk for the development of ocular pathology, thus allowing preventive intervention, and to design more effective therapeutic interventions once the disease has become clinically manifest.
Wiersinga
Wilmar M
WM
Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, The Netherlands. w.m.wiersinga@amc.uva.nl
D005128:Eye Diseases / Q000517:prevention & control / Q000628:therapy*; D006111:Graves Disease / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D010348:Patient Care Team; D010358:Patient Participation; D012907:Smoking / Q000009:adverse effects; D000074606:Smoking Prevention