| A Consensus-Based Clinical Activity Score (CAS) Atlas for Thyroid Eye Disease in East Asian Patients: A KSOPRS Initiative |
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Dongheon Surl1, JaeSang Ko1, Min Joung Lee3, Jeong Kyu Lee4, JunHyuk Son5, Namju Kim6, Jaewook Yang7, Jin Sook Yoon2 |
1Department of Ophthalmology, Yongin Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Yongin, Republic of Korea
2Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
3Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
4Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
5Department of Ophthalmology, College of medicine, YeungNam University, Daegu, Republic of Korea
6Department of Ophthalmology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
7Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea |
Correspondence:
Jaewook Yang, Tel: +82-51-890-6356, Fax: +82-51-890-6329,
Email: jwyang@paik.ac.kr
Jin Sook Yoon, Tel: +82-2-2228-3570, Fax: +82-2-312-0541,
Email: yoonjs@yuhs.ac
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Received: 11 March 2026 • Revised: 29 April 2026 • Accepted: 30 April 2026 |
| Abstract |
Purpose
To develop a consensus-based photographic atlas tailored to East Asian patients to improve the consistency and clinical applicability of the Clinical Activity Score (CAS) in thyroid eye disease (TED), while maintaining compatibility with the established CAS framework.
Methods
Under the auspices of the Korean Society of Ophthalmic Plastic and Reconstructive Surgery (KSOPRS), an expert Atlas Committee comprising eight TED specialists curated representative clinical photographs corresponding to the five sign-based CAS items: eyelid swelling, eyelid erythema, conjunctival redness, conjunctival swelling, and inflammation of the caruncle or plica. Images were categorized as CAS-positive or CAS-negative following multiple rounds of expert review and discussion. The finalized atlas was circulated to all KSOPRS members for consensus approval.
Results
The atlas provides standardized photographic panels and concise operational guidance for each sign-based CAS item. East Asian–specific considerations, including thicker eyelid skin, fuller preseptal and septal fat, and epicanthal folds, are incorporated to refine interpretation of inflammatory signs that may appear attenuated compared with photographic references derived from white populations of European ancestry. The atlas emphasizes pattern recognition, distribution of findings, and side-to-side comparison rather than absolute intensity of erythema or swelling, aiming to reduce false-negative judgments and improve inter-observer consistency.
Conclusions
This ethno-specific standard photographic atlas enables endocrinologists and ophthalmologists to perform rapid and reproducible assessments in outpatient settings, facilitating the early identification of patients requiring referral or urgent treatment. |
| Key Words:
Clinical activity score; East Asian; Ethno-specific standardization; Photographic atlas; Thyroid eye disease |
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