One study, as an example, evaluated 237 patients with newly diagnosed Graves' hyperthyroidism who were treated with thionamides [ 1 ]. At initial presentation, the majority ( percent) of patients had no ocular involvement, whereas mild, moderate-to-severe, and sight-threatening orbitopathy were present in 20, , and percent of patients, respectively. During the 18-month follow-up period, progression to moderate-to-severe orbitopathy occurred in percent of patients with no orbitopathy at baseline and in percent of patients with mild activity at baseline. In contrast, 58 percent of patients with mild disease at baseline experienced complete remission.
Vision (V) evaluates the visual repercussion particularly due to the development of dysthyroid optic neuropathy. This is assessed through visual acuity, pupillary reflexes, color vision, visual fields, optic nerve examination, and visual evoked potentials. Most of these tests should be performed in all patients, as optic neuropathy frequently occurs in patients with little or no proptosis. CT scans may be necessary in selected cases to confirm the presence of an orbital apex syndrome or before surgical decompression (Figure 1 ).
Regarding older images: Photos in the "Older image" category were primarily donated to EyeRounds by Dr. William C. Caccamise, Sr., who generously shared these images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. Many of his images are significant for their historical perspective and for techniques and conditions seen in settings in under-developed areas. The precise dates of these are unknown, they are all listed as 1970 for the purpose of labeling them for the search tool.