Investigating the Correlation Between Choroidal Alteration and Visual Function Metrics in Dysthyroid Optic Neuropathy

Purpose: This study evaluates the relationship between choroidal and optic disc alterations and visual function metrics (visual acuity, pattern visual evoked potential [P-VEP], and visual field) in patients with dysthyroid optic neuropathy (DON). Methods: A retrospective cross-sectional study included 38 patients with thyroid eye disease (TED). Three-dimensional choroidal data, including thickness, vascular metrics, and optic disc measurements, were obtained using TowardPi wide-field optical coherence tomography angiography (OCTA). Visual function was assessed using P-VEP and automated perimetry. Results: The study analyzed 27 eyes with inactive TED, 22 with active non-DON TED, and 27 with DON. Visual acuity worsened with TED severity (P = 0.024), and mean sensitivity (MS) decreased (P = 0.024). P-VEP amplitude at 0.25 degrees was lower in DON (P = 0.024). Significant correlations were found between optic disc choroidal vascularity index and MS (R = 0.413, P < 0.001), nasal superior region choroidal metrics and MS (R = 0.450, P < 0.001), and retinal nerve fiber layer blood flow density with MS (R = 0.387, P = 0.001) and P-VEP amplitude at 0.25 degrees (R = 0.311, P = 0.021). Conclusions: Choroidal alterations are closely linked to visual function in DON. Choroidal thickness (CT) and vascularity may serve as biomarkers for assessing disease activity and visual impairment, aiding clinical management. Translational Relevance: This study identifies choroidal alterations as potential biomarkers for assessing disease activity and visual impairment in DON, which can aid in clinical decision making and personalized patient management.