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January 17, 2026<\/p>\n
1 min read<\/p>\n<\/p><\/div>\n
\n \n \n Add topic to email alerts \n <\/span> \n <\/p>\n\n\n \n Receive an email when new articles are posted on \n <\/p>\n\n Please provide your email address to receive an email when new articles are posted on .<\/p><\/div>\n<\/p><\/div>\n “ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nVISA assesses vision, inflammatory findings, strabismus and appearance.<\/li>\nPrioritize smoking cessation and endocrine status while avoiding treatment with radioactive iodine in patients with active disease.<\/li>\n<\/ul>\nWAIKOLOA, Hawaii \u2014 The VISA classification system is a helpful tool for monitoring disease progression in patients with thyroid eye disease, according to a speaker here.<\/p>\nAt Hawaiian Eye 2026, Mark J. Lucarelli, MD, FACS,<\/b> <\/b>said that the VISA system assesses thyroid eye disease (TED) progression by primarily focusing on vision outcomes, inflammatory findings, strabismus and appearance.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\n\u201cFirst and foremost, we want to know if there is visual compromise,\u201d he said. \u201cIs there thyroid optic neuropathy, or exposure keratopathy? Second, we\u2019re looking at inflammatory findings.\u201d<\/p>\nVISA implements a 10-point inflammation scale designed to allow ophthalmologists to track whether the patient\u2019s symptoms have improved, remained the same or progressed at the end of their visit. For example, the presence of minor chemosis or lid edema would add one point on the scale, while more severe cases would add two points. Lucarelli shared a case in which patient scored a six out of 10, \u201cthat would usually be at the level that would trigger some more advanced therapy,\u201d he said.<\/p>\n\u201cIt gives us a way to very rapidly understand that the patient is not having immediate visual compromise, but that they are rather inflamed,\u201d he said. \u201cThey have moderate to severe strabismus, and very severe proptosis. We have one quick classification, and a pretty good understanding of this patient’s condition, at least at one point in time.\u201d<\/p>\nIn addition to implementing the VISA system, Lucarelli stressed the other \u201cbig three\u201d modifiable steps for treating every patient with TED: Smoking cessation, managing the endocrine status and avoiding treatment with radioactive iodine while disease is active. <\/p>\n \u201cCycling between hyperthyroidism and hypothyroidism is terrible for these patients,\u201d Lucarelli said. \u201cWe need to stabilize their endocrine system. Most endocrinologists understand this, but it doesn’t hurt for us to encourage them.\u201d<\/p>\nFor patients with more severe, active TED, Lucarelli recommended that they consider undergoing thyroidectomy, which has been associated with lower incidences of orbital decompression and optic neuropathy. <\/p>\n\u201cBy managing these risk factors, we can really stack the deck for better outcomes for our patients,\u201d he said.<\/p>\n
\n Receive an email when new articles are posted on \n <\/p>\n\n Please provide your email address to receive an email when new articles are posted on .<\/p><\/div>\n<\/p><\/div>\n “ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nVISA assesses vision, inflammatory findings, strabismus and appearance.<\/li>\nPrioritize smoking cessation and endocrine status while avoiding treatment with radioactive iodine in patients with active disease.<\/li>\n<\/ul>\nWAIKOLOA, Hawaii \u2014 The VISA classification system is a helpful tool for monitoring disease progression in patients with thyroid eye disease, according to a speaker here.<\/p>\nAt Hawaiian Eye 2026, Mark J. Lucarelli, MD, FACS,<\/b> <\/b>said that the VISA system assesses thyroid eye disease (TED) progression by primarily focusing on vision outcomes, inflammatory findings, strabismus and appearance.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\n\u201cFirst and foremost, we want to know if there is visual compromise,\u201d he said. \u201cIs there thyroid optic neuropathy, or exposure keratopathy? Second, we\u2019re looking at inflammatory findings.\u201d<\/p>\nVISA implements a 10-point inflammation scale designed to allow ophthalmologists to track whether the patient\u2019s symptoms have improved, remained the same or progressed at the end of their visit. For example, the presence of minor chemosis or lid edema would add one point on the scale, while more severe cases would add two points. Lucarelli shared a case in which patient scored a six out of 10, \u201cthat would usually be at the level that would trigger some more advanced therapy,\u201d he said.<\/p>\n\u201cIt gives us a way to very rapidly understand that the patient is not having immediate visual compromise, but that they are rather inflamed,\u201d he said. \u201cThey have moderate to severe strabismus, and very severe proptosis. We have one quick classification, and a pretty good understanding of this patient’s condition, at least at one point in time.\u201d<\/p>\nIn addition to implementing the VISA system, Lucarelli stressed the other \u201cbig three\u201d modifiable steps for treating every patient with TED: Smoking cessation, managing the endocrine status and avoiding treatment with radioactive iodine while disease is active. <\/p>\n \u201cCycling between hyperthyroidism and hypothyroidism is terrible for these patients,\u201d Lucarelli said. \u201cWe need to stabilize their endocrine system. Most endocrinologists understand this, but it doesn’t hurt for us to encourage them.\u201d<\/p>\nFor patients with more severe, active TED, Lucarelli recommended that they consider undergoing thyroidectomy, which has been associated with lower incidences of orbital decompression and optic neuropathy. <\/p>\n\u201cBy managing these risk factors, we can really stack the deck for better outcomes for our patients,\u201d he said.<\/p>\n
“ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nVISA assesses vision, inflammatory findings, strabismus and appearance.<\/li>\nPrioritize smoking cessation and endocrine status while avoiding treatment with radioactive iodine in patients with active disease.<\/li>\n<\/ul>\nWAIKOLOA, Hawaii \u2014 The VISA classification system is a helpful tool for monitoring disease progression in patients with thyroid eye disease, according to a speaker here.<\/p>\nAt Hawaiian Eye 2026, Mark J. Lucarelli, MD, FACS,<\/b> <\/b>said that the VISA system assesses thyroid eye disease (TED) progression by primarily focusing on vision outcomes, inflammatory findings, strabismus and appearance.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\n\u201cFirst and foremost, we want to know if there is visual compromise,\u201d he said. \u201cIs there thyroid optic neuropathy, or exposure keratopathy? Second, we\u2019re looking at inflammatory findings.\u201d<\/p>\nVISA implements a 10-point inflammation scale designed to allow ophthalmologists to track whether the patient\u2019s symptoms have improved, remained the same or progressed at the end of their visit. For example, the presence of minor chemosis or lid edema would add one point on the scale, while more severe cases would add two points. Lucarelli shared a case in which patient scored a six out of 10, \u201cthat would usually be at the level that would trigger some more advanced therapy,\u201d he said.<\/p>\n\u201cIt gives us a way to very rapidly understand that the patient is not having immediate visual compromise, but that they are rather inflamed,\u201d he said. \u201cThey have moderate to severe strabismus, and very severe proptosis. We have one quick classification, and a pretty good understanding of this patient’s condition, at least at one point in time.\u201d<\/p>\nIn addition to implementing the VISA system, Lucarelli stressed the other \u201cbig three\u201d modifiable steps for treating every patient with TED: Smoking cessation, managing the endocrine status and avoiding treatment with radioactive iodine while disease is active. <\/p>\n \u201cCycling between hyperthyroidism and hypothyroidism is terrible for these patients,\u201d Lucarelli said. \u201cWe need to stabilize their endocrine system. Most endocrinologists understand this, but it doesn’t hurt for us to encourage them.\u201d<\/p>\nFor patients with more severe, active TED, Lucarelli recommended that they consider undergoing thyroidectomy, which has been associated with lower incidences of orbital decompression and optic neuropathy. <\/p>\n\u201cBy managing these risk factors, we can really stack the deck for better outcomes for our patients,\u201d he said.<\/p>\n
Back to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nVISA assesses vision, inflammatory findings, strabismus and appearance.<\/li>\nPrioritize smoking cessation and endocrine status while avoiding treatment with radioactive iodine in patients with active disease.<\/li>\n<\/ul>\nWAIKOLOA, Hawaii \u2014 The VISA classification system is a helpful tool for monitoring disease progression in patients with thyroid eye disease, according to a speaker here.<\/p>\nAt Hawaiian Eye 2026, Mark J. Lucarelli, MD, FACS,<\/b> <\/b>said that the VISA system assesses thyroid eye disease (TED) progression by primarily focusing on vision outcomes, inflammatory findings, strabismus and appearance.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\n\u201cFirst and foremost, we want to know if there is visual compromise,\u201d he said. \u201cIs there thyroid optic neuropathy, or exposure keratopathy? Second, we\u2019re looking at inflammatory findings.\u201d<\/p>\nVISA implements a 10-point inflammation scale designed to allow ophthalmologists to track whether the patient\u2019s symptoms have improved, remained the same or progressed at the end of their visit. For example, the presence of minor chemosis or lid edema would add one point on the scale, while more severe cases would add two points. Lucarelli shared a case in which patient scored a six out of 10, \u201cthat would usually be at the level that would trigger some more advanced therapy,\u201d he said.<\/p>\n\u201cIt gives us a way to very rapidly understand that the patient is not having immediate visual compromise, but that they are rather inflamed,\u201d he said. \u201cThey have moderate to severe strabismus, and very severe proptosis. We have one quick classification, and a pretty good understanding of this patient’s condition, at least at one point in time.\u201d<\/p>\nIn addition to implementing the VISA system, Lucarelli stressed the other \u201cbig three\u201d modifiable steps for treating every patient with TED: Smoking cessation, managing the endocrine status and avoiding treatment with radioactive iodine while disease is active. <\/p>\n \u201cCycling between hyperthyroidism and hypothyroidism is terrible for these patients,\u201d Lucarelli said. \u201cWe need to stabilize their endocrine system. Most endocrinologists understand this, but it doesn’t hurt for us to encourage them.\u201d<\/p>\nFor patients with more severe, active TED, Lucarelli recommended that they consider undergoing thyroidectomy, which has been associated with lower incidences of orbital decompression and optic neuropathy. <\/p>\n\u201cBy managing these risk factors, we can really stack the deck for better outcomes for our patients,\u201d he said.<\/p>\n
WAIKOLOA, Hawaii \u2014 The VISA classification system is a helpful tool for monitoring disease progression in patients with thyroid eye disease, according to a speaker here.<\/p>\n
At Hawaiian Eye 2026, Mark J. Lucarelli, MD, FACS,<\/b> <\/b>said that the VISA system assesses thyroid eye disease (TED) progression by primarily focusing on vision outcomes, inflammatory findings, strabismus and appearance.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\n\u201cFirst and foremost, we want to know if there is visual compromise,\u201d he said. \u201cIs there thyroid optic neuropathy, or exposure keratopathy? Second, we\u2019re looking at inflammatory findings.\u201d<\/p>\nVISA implements a 10-point inflammation scale designed to allow ophthalmologists to track whether the patient\u2019s symptoms have improved, remained the same or progressed at the end of their visit. For example, the presence of minor chemosis or lid edema would add one point on the scale, while more severe cases would add two points. Lucarelli shared a case in which patient scored a six out of 10, \u201cthat would usually be at the level that would trigger some more advanced therapy,\u201d he said.<\/p>\n\u201cIt gives us a way to very rapidly understand that the patient is not having immediate visual compromise, but that they are rather inflamed,\u201d he said. \u201cThey have moderate to severe strabismus, and very severe proptosis. We have one quick classification, and a pretty good understanding of this patient’s condition, at least at one point in time.\u201d<\/p>\nIn addition to implementing the VISA system, Lucarelli stressed the other \u201cbig three\u201d modifiable steps for treating every patient with TED: Smoking cessation, managing the endocrine status and avoiding treatment with radioactive iodine while disease is active. <\/p>\n \u201cCycling between hyperthyroidism and hypothyroidism is terrible for these patients,\u201d Lucarelli said. \u201cWe need to stabilize their endocrine system. Most endocrinologists understand this, but it doesn’t hurt for us to encourage them.\u201d<\/p>\nFor patients with more severe, active TED, Lucarelli recommended that they consider undergoing thyroidectomy, which has been associated with lower incidences of orbital decompression and optic neuropathy. <\/p>\n\u201cBy managing these risk factors, we can really stack the deck for better outcomes for our patients,\u201d he said.<\/p>\n
\u201cFirst and foremost, we want to know if there is visual compromise,\u201d he said. \u201cIs there thyroid optic neuropathy, or exposure keratopathy? Second, we\u2019re looking at inflammatory findings.\u201d<\/p>\n
VISA implements a 10-point inflammation scale designed to allow ophthalmologists to track whether the patient\u2019s symptoms have improved, remained the same or progressed at the end of their visit. For example, the presence of minor chemosis or lid edema would add one point on the scale, while more severe cases would add two points. Lucarelli shared a case in which patient scored a six out of 10, \u201cthat would usually be at the level that would trigger some more advanced therapy,\u201d he said.<\/p>\n
\u201cIt gives us a way to very rapidly understand that the patient is not having immediate visual compromise, but that they are rather inflamed,\u201d he said. \u201cThey have moderate to severe strabismus, and very severe proptosis. We have one quick classification, and a pretty good understanding of this patient’s condition, at least at one point in time.\u201d<\/p>\n
In addition to implementing the VISA system, Lucarelli stressed the other \u201cbig three\u201d modifiable steps for treating every patient with TED: Smoking cessation, managing the endocrine status and avoiding treatment with radioactive iodine while disease is active. <\/p>\n
\u201cCycling between hyperthyroidism and hypothyroidism is terrible for these patients,\u201d Lucarelli said. \u201cWe need to stabilize their endocrine system. Most endocrinologists understand this, but it doesn’t hurt for us to encourage them.\u201d<\/p>\n
For patients with more severe, active TED, Lucarelli recommended that they consider undergoing thyroidectomy, which has been associated with lower incidences of orbital decompression and optic neuropathy. <\/p>\n
\u201cBy managing these risk factors, we can really stack the deck for better outcomes for our patients,\u201d he said.<\/p>\n
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