A Nationwide Survey by the Korean Society of Ophthalmic Plastic and Reconstructive Surgery (KSOPRS) on the Management of Thyroid Eye Disease in South Korea

Abstract

OBJECTIVE: To evaluate current diagnostic and therapeutic practices among South Korean oculoplastic surgeons, with particular focus on adherence to guidelines and perspectives on emerging therapies such as teprotumumab. METHODS: A nationwide, anonymized online survey was conducted in May 2025 among members of the Korean Society of Ophthalmic Plastic and Reconstructive Surgery (KSOPRS). The questionnaire collected data on physician demographics, diagnostic and monitoring approaches, therapeutic strategies for mild and moderate-to-severe thyroid eye disease (TED), management of dysthyroid optic neuropathy, and perspectives on teprotumumab treatment. RESULTS: Thirty-two physicians participated in the study, most of whom practiced at tertiary centers. Most respondents (n = 28, 87.5%) utilized the Clinical Activity Score and the European Group on Graves' Orbitopathy severity classification. Intravenous (IV) glucocorticoid (GC) therapy was the predominant treatment for moderate-to-severe TED (n = 31, 96.9%), with adjunctive use of oral GCs, immunosuppressants (n = 13, 40.6%), and orbital radiotherapy (n = 29, 90.6%). In managing dysthyroid optic neuropathy, 19 respondents (59.4%) employed IV GC with radiotherapy, and 29 (90.6%) recommended decompression for refractory cases. Teprotumumab was considered primarily for GC-refractory cases, although its use was limited owing to cost and limited clinical experience. Functional assessments, including visual acuity and relative afferent pupillary defect, were prioritized over structural imaging in evaluating treatment response. CONCLUSIONS: South Korean oculoplastic surgeons generally follow international TED guidelines, favoring IV GC and conventional therapies over biologics due to access and cost barriers. As biologics like teprotumumab become more accessible, region-specific guidelines integrating global evidence and local healthcare constraints will be critical for optimized patient care.