It is an honor to serve as the guest editor for this special edition of the Taiwan Journal of Ophthalmology, “Update and Advances in Thyroid Eye Disease (TED).” It was not long ago that our understanding and treatment options for TED were minimal. The factors involved in the autoimmune process were poorly understood. Steroids, radiation, and surgery were among the limited options that were available to physicians and patients. Recently, there has been a greater understanding of the disease processes at the molecular level, as well as a blossoming of the treatment options available. The special edition highlights some of these and I wish to thank all the authors for their exceptional contributions.
The first article is a review article by Dr. Jin Sook Yoon. Dr. Yoon has been a great contributor and an authority in the understanding of TED pathophysiology and is an outstanding basic science researcher and clinician scientist. Dr. Yoon's review article dives deeply into current knowledge of TED pathophysiology. Her conceptual understanding and insight into the molecular mechanisms that drive this fascinating disease are at the expert level. Drs. Tammy and Midori Osaki from Sao Paolo, Brazil, are the first and senior authors for the second review article. Their in-depth analysis and experience from their extensive clinical practice are unparalleled as they examine the treatment options available for eyelid retraction. Several articles by Dr. Bradford Lee and his co-authors are at the leading edge of TED therapeutics. Biologic therapy for thyroid eye disease is front and center of current treatment regimens and he shares his experience with tocilizumab.
Surgical options are also have also evolved. It was once felt that orbital decompression was a high-risk procedure that should only be reserved for cases of optic neuropathy and risk of blindness. Dr. Lee has been busy expanding the envelope in investigating new options to assist with surgical management. Image navigation is preferred by many surgeons and Dr. Lee examined this more in depth for orbital decompression. While it remains to be seen if image navigation will become the standard of care, his study does show some benefit. Orbital decompression with the bony removal of the rim has also been a controversial topic and he also shares his experience with rim removal only to reduce proptosis without canthal deformity. Finally, during the COVID pandemic, widespread vaccinations have been implemented to reduce the incidence of serious infections. However, perhaps, an unintended consequence is the flaring of many autoimmune diseases. Dr. Katherine Park shares our experience with a few cases that precipitated or worsened TED after vaccination.
I hope you enjoy reading these articles and again, thanks to the TJO for giving me this opportunity to serve as guest editor. I would like to thank the Editor in Chief, Dr. David Hui-Kang Ma, and my colleagues and good friends, Dr. Shu-Lang Liao and Dr. Cheng-Hsien Chang for the opportunity to serve in this capacity. Finally, I would also like to acknowledge and thank Cindy Chen for her kind and diligent attention to this issue and for shepherding me through the process and Chris Hui for expert typesetting and editing.