title: Treatment of severe thyroid eye disease: a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).
abstract: OBJECTIVE
  To evaluate the current practice patterns for the treatment of severe thyroid eye disease (TED) in the United States by conducting a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery.
  
  
  METHODS
  This is a questionnaire study. The survey encompassed the use of different modalities, including intravenous steroids, oral steroids, orbital decompression, orbital radiation, intraorbital steroid injections, and steroid-sparing biologic agents, in the treatment of severe TED. Specifics on the dosing regimens of steroids and types of decompression used were queried.
  
  
  RESULTS
  With regard to treatments used "at all" in the management of severe TED, 87% use oral steroids and 74% use intravenous steroids. Eighty-three percent use orbital decompression, 70% use radiation, 33% use biologic agents, and 28% use intraorbital steroid injections. Oral steroids were slightly preferred to intravenous steroids at 43% versus 40% for first-line treatment. Most responders (61%) chose 2-wall decompression as their preferred technique.
  
  
  CONCLUSIONS
  Severe TED can be a devastating disease leading to diplopia and vision loss. Treatment recommendations have varied and continue to evolve. The survey reported herein found that oral steroids were slightly preferred over intravenous steroids by the members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, most of who practice in the United States. This is in contrast to survey results from European and Latin American physicians, which more strongly favored intravenous steroids. In addition, orbital decompression and orbital radiation still play significant roles in the management of severe TED.
authors.affiliation: Department of Ophthalmology, Lions Eye Institute, Albany Medical Center, New York, U.S.A.
authors.forename: Balaji
authors.initials: B
authors.lastname: Perumal
authors.forename: Dale R
authors.initials: DR
authors.lastname: Meyer
mesh_terms: D001685:Biological Factors / Q000008:administration & dosage; D044964:Cervicoplasty; D019299:Decompression, Surgical; D005938:Glucocorticoids / Q000008:administration & dosage; D049970:Graves Ophthalmopathy / Q000628:therapy*; D006306:Health Surveys; D006801:Humans; D009885:Ophthalmology / Q000458:organization & administration / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures; D012955:Societies, Medical / Q000458:organization & administration; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D001685:Biological Factors; D005938:Glucocorticoids