The Center of Excellence for TED Treatment
Cutting edge clinical care with 15+ years of experience specializing in and treating Thyroid Eye Disease | OCULOPLASTIC SURGERY & AESTHETICS
Raymond Douglas, MD, PhD
THE CENTER OF EXCELLENCE FOR TED TREATMENT
- Dr. Raymond Douglas, a world-renowned oculoplastic surgeon and leading expert in Thyroid Eye Disease (TED), provides cutting edge medical and surgical care for patients with TED.
- Dr. Douglas was integral in the development of Tepezza and was the first person in the world to treat patients following FDA approval in 2020.
- Our center of excellence supports patients as they navigate the different treatment solutions available and attainable to reclaim their health.
- We offer non-surgical and surgical treatment solutions. Our physicians will work with you to determine a customized care plan.
- Our team of experts can assist with insurance approval and financing, allowing you to focus on what matters most – your wellness journey.
THYROID EYE DISEASE
MOLECULAR CAUSES
The primary cause of thyroid eye disease is the overexpression of a receptor which regulates the metabolism of cells. The receptor is the IGF-1R and is overexpressed just on TED tissues. The overexpression leads to increase production of scar tissue components. Based upon many years of research the receptor can be blocked and the metabolism can return to normal. This has led to break through treatments for TED.
CLINICAL APPEARANCE
Some of the most common symptoms of thyroid eye disease include:
- Inability to close your eyes completely
- Bulging eyes
- Double vision
- Dry eye
- Eye irritation
- Redness and inflammation of the eyeball
- Pressure behind or around the eyes
- Swelling and redness of the eyelids
- In rare cases, untreated thyroid eye disease can impact your vision and lead to vision loss
WHAT TREATMENTS ARE AVAILABLE?
Some of the main issues with TED causing discomfort are dryness, pain and blurry vision. This can be helped with lubrication artificial tears but must be used frequently. Ointments and even taping the eyelids at night can also help.
Tepezza emerged from decades of research with large contributions from Dr. Douglas and Dr. Smith. The drug was considered a breakthrough in therapy by the FDA and is the first and only approved therapy for TED in the US. Tepezza binds to the IGF-1R and blocks the increased production of molecules for fibrosis. It is a targeted treatment which is why it is well tolerated. It reduces eye bulging and double vision in patients with TED no matter how long they have had the disease. Research from multiple international clinical trials has clearly shown its effectiveness. In addition it reverses double vision and the facial changes associated with the disease. As with any medication it can have side effects but these appear to be temporary and occur infrequently. In one study by Dr. Douglas, 98% of patients were pleased with treatment.
Surgery is often reserved for late stages and can help return the appearance and function. Customized surgery can be done to correct eye bulging, eyelid retraction and facial changes in a single surgery. In some cases, surgery to correct double vision is also needed.
Medical therapies such as radiation, steroids, rituximab, tociluzimab are all non-FDA approved treatments with limited success. In general theses therapies have not been shown to significantly alter the disease course or are for mild cases.
Diet is often overlooked in autoimmune diseases but a gluten free, plant-based diet has been beneficial for many patients. This can decrease the inflammation associated with the disease especially in active phase. Selenium supplementation may also be useful in patients with early, mild disease.
WHAT TREATMENTS ARE RIGHT FOR ME?
Expert opinion on all therapies
Thyroid eye disease is a heterogenous disease – meaning that it can affect everyone differently. That’s why a customized approach is key. It is very important to seek an expert who is both knowledgeable in and has experience in treating patients with TED. Each consultation should include an examination and discussion of both medical and surgical options. Medical options, which primarily include Tepezza, can be considered for anyone with TED in either active or stable phases as it has been shown effective in both stages of disease. A comprehensive discussion of benefits and risks should be discussed based on the individual’s underlying health and co-existing medical conditions. In addition, discussion of surgical options, benefits and limitations should also be clear and understandable. Some patients may only need medical treatment, others may opt for surgery when stable. In some cases, patients have a significant improvement following medical treatment that allows for much smaller, less invasive, surgeries
FINDING EXPERT CARE AND WHAT TO LOOK FOR
TED SPECIALIST WITH EXPERIENCE
Finding a TED specialist can be difficult. One place to start is looking for an oculoplastic surgeon in the community. It is important to make sure that any specialist you go to has experience managing TED patients specifically or is willing to refer you to a specialist who has.
WILLING TO DISCUSS ALL TREATMENTS
In considering a provider it is important to discuss all treatments alternatives. 1. Observation, when appropriate 2. Supportive measures and medical therapy and 3. Surgical treatments. Each option may not be appropriate, or more than one may be, but it is important to discuss all options before proceeding. A knowledgeable physician will be able to give clear answers regarding risks and benefits of each option.
COMPREHENSIVE APPROACH
Areas that are overlooked in treatment by medical professionals is often the role of diet and lifestyle modification. There are a limited number of things patient can do to help their disease however stopping smoking or tobacco use of any kind has been well established. The importance of diet is often overlooked. Autoimmune diets are a good place to start but often have to be individualized based upon response. Adopting a gluten free, plant-based diet has been shown to reduce inflammation and is an excellent first step.
SURGERY TO IMPROVE FUNCTION AND APPEARANCE
Many TED professionals will discuss surgery as an option when the disease is moderate to severe and causing functional impairment. However, we know that in addition to causing many adverse symptoms, TED also causes a change in facial shape and appearance that can have significant psychosocial impact on patients and their quality of life. For example surgery to reduce the bulging of eye can dramatically improve appearance but should be done in a customized way and in addition to other surgical procedures to improve appearance. Decompression surgery can be done on both sides and often combined with eyelid surgery to reduce bulkiness or eyelid opening. Buccal fat removal is also a common procedure to improve facial changes and restore the shape of the face by reducing cheek fat which often enlarges with the disease.