SEEING BEYOND THE SURFACE and Thyroid Care in Thyroid Eye Disease (TED)

INTEGRATING VISION CARE

By: Lennard M. Goetze, Ed.D

Thyroid Eye Disease (TED) is one of the more complex and often misunderstood complications associated with thyroid disorders—one that reaches far beyond the surface symptoms of bulging eyes, eyelid retraction, or dryness. For Dr. Angela Mazza, a nationally recognized endocrinologist and chief clinical advisor to THYROIDSCAN.org, this condition underscores the importance of a truly multidisciplinary approach to thyroid health. Dr. Mazza’s work spans the full spectrum of thyroid disorders, from early detection of autoimmune thyroiditis to advanced imaging for structural and vascular changes. Her emphasis on integrating endocrinology with other specialties has paved the way for deeper collaborations that address the whole patient—not just the hormone levels.

This collaborative philosophy aligns perfectly with the insights of Dr. William Padula, a leading expert in NeuroVisual processing, whose work brings an often-overlooked dimension to TED care: the transformation of visual processing systems.

According to Dr. Padula, TED originates from an overactive thyroid that alters hormonal balance and overstimulates certain neurotransmitters. This, in turn, activates the third cranial nerve, elevating the eyelid and triggering hyper-focalization of the visual system. “It becomes not only uncomfortable from keeping the eyes open and managing constant strain and dryness,” he explains, “but the whole visual process changes.”

Dr. Padula describes two primary visual processing systems:

1.     The spatial platform system – the “forest view” that integrates posture, movement, and spatial orientation.

2.     The detail-focused system – the “tree view” that isolates and examines fine details.

In a healthy individual, these systems work in harmony, allowing a person to see a tree within the context of the forest. But in TED, the spatial platform becomes compromised, leaving the detail-oriented system unchecked. “Suddenly,” says Dr. Padula, “the whole forest turns into trees.” This imbalance disrupts posture, movement, and overall visual coordination.

The medical community—endocrinologists, functional medicine practitioners, integrative health specialists, and radiologists—plays a critical role in stabilizing the thyroid and managing inflammation. However, Dr. Padula stresses that optimal recovery also requires the involvement of a NeuroVisual processing specialist. By rebalancing visual processing, neuroreceptors and neurotransmitters can normalize, reinforcing the effects of medical treatment.

One of the tools he highlights is yoked prism therapy. For patients with third nerve overactivation and elevated eyelids, carefully applied base-up yoked prisms can realign posture and reduce the neurological trigger for eyelid elevation. “There’s a need for a better understanding of the visual process—not just 20/20 acuity—among endocrinologists and all medical professionals,” Dr. Padula emphasizes.

The future of TED treatment, as both Dr. Mazza and Dr. Padula suggest, lies in integrative vision-endocrine care—where imaging, hormone regulation, and NeuroVisual rehabilitation work in concert. Such collaboration ensures that patients don’t just regain biochemical balance but also recover the visual harmony essential for daily life.

By recognizing TED as more than an ocular manifestation of thyroid disease, the medical community can help patients truly see the forest again—not just the trees.

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Quick Facts on Thyroid Eye Disease (TED)

·        What it is: An autoimmune inflammatory disorder affecting the eyes, often linked to overactive thyroid (Graves’ disease) but can also occur in hypothyroidism or even in normal thyroid function.

·        Primary symptoms: Bulging eyes (proptosis), eyelid retraction, dryness, eye pain, double vision, and changes in visual processing.

·        Underlying mechanism: Overstimulation of neurotransmitters and muscles around the eyes due to thyroid hormone imbalance, impacting both eye movement and visual processing systems.

·        Two vision systems affected:

o       Spatial platform system – provides overall context (“forest view”).

o       Detail-oriented system – focuses on specifics (“tree view”).
When unbalanced, patients lose integration between the two, affecting posture, coordination, and perception.

·        Why prisms can help: Yoked prism lenses can improve posture, reduce eyelid elevation triggers, and restore visual balance when paired with medical management.

·        Best care approach: A combined effort between endocrinologists, radiologists, functional medicine practitioners, and NeuroVisual specialists.

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Restoring Vision Through Collaborative Thyroid Care

Afterthought by: Dr. Angela Mazza, DO

As an endocrinologist, I am often the first point of contact for patients experiencing the earliest signs of thyroid disease. My role begins with identifying and managing the underlying hormonal imbalance—whether it is hyperthyroidism from Graves’ disease, autoimmune thyroiditis, or another thyroid dysfunction. However, thyroid disease is not confined to the hormone panel in a lab report. It has systemic effects—impacting the cardiovascular system, metabolism, bone health, and, as we see with Thyroid Eye Disease (TED), the very way a patient interacts with the world visually.

TED develops when autoimmune activity triggers inflammation of the tissues around the eyes, including the extraocular muscles and connective tissues. This swelling can cause the hallmark symptoms—bulging eyes, eyelid retraction, double vision, and pain. From my perspective, these symptoms are not merely cosmetic concerns; they are indicators of active autoimmune disease that may require urgent intervention. Controlling thyroid hormone levels—often with antithyroid drugs, radioactive iodine, or thyroid surgery—is essential, but the hormonal treatment alone may not reverse the ocular changes once they’ve set in.

This is why collaboration with specialists like Dr. William Padula is so important. His work reveals a dimension of TED that is often invisible to conventional thyroid care—how the disease changes NeuroVisual processing. While endocrinology focuses on reducing inflammation and normalizing hormone output, NeuroVisual specialists can address how the brain and eyes adapt—or fail to adapt—to these changes.

We now understand that TED is not simply a “mechanical” pushing forward of the eyes. It is a complex interplay between autoimmune inflammation, hormonal fluctuations, and neural pathways controlling visual perception. Even after hormone levels stabilize, a patient may continue to experience eye strain, double vision, or spatial disorientation because the brain’s visual processing systems have adapted to a compromised platform. Without targeted rehabilitation, those adaptations may persist.

This integrated view—where endocrinologists and NeuroVisual specialists share responsibility for patient outcomes—should be the standard for TED care. As we advance, I see great promise in combining hormonal control, imaging technologies, and NeuroVisual rehabilitation. Together, these approaches can not only prevent disease progression but also restore function, comfort, and quality of life.

TED challenges us to look beyond the numbers on a thyroid panel and see the patient’s experience in full—because restoring thyroid health must also mean restoring the way they see their world.

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BIOMETRICS THROUGH QUANTITATIVE OPTICSCAN

By: Robert L. Bard, MD

 

INTRODUCTION

A new research study is underway at the Bard Diagnostic Imaging Center in NYC. Dr. Robert Bard and a local research team combines the latest biometric scanning advantages of transcranial DOPPLER imaging,  hemodynamic ULTRASOUND scanning (of the retinal, basilary and temporal arteries) and the integration of BIOFEEDBACK technology for a special research study. This neuro-scan review establishes (1) a cross-comparative study  between the technologies and (2) a multi-modality screening & monitoring protocol to record post-concussion and neurodegenerative disorders.

 

One of several major foci for this project is to explore the development of a diagnostic paradigm in the detection of post concussion symptoms including the growing reports of Chronic Traumatic Encephalopathy/CTE, identified from head concussions in military service and high impact sports.  Since 2018, Dr. Bard has been collaborating with neurologists and pain management specialists to assess the rampant growth of this progressive brain condition. 

 

INTRACRANIAL PRESSURE

Case studies with a presumptive degenerative neuromuscular disease or amyotrophic lateral sclerosis are now being examined through a non-invasive investigation of the eye.   We can observe increased intracranial pressure, which may reflect in changes in the optic nerve diameter.  [Fig. 1]  Scan of the eye (L) with a Doppler ultrasound probe shows the optic nerve diameter of five millimeters compared to the usually symmetric right almost eight millimeters. This suggests increased intracranial pressure or optic nerve tumor indicating a blood flow measure of the right anterior cerebral artery circulation that supplies the retina (approximately 60cm/s) blood flow. 

 

 

[Fig. 2] The left vessel shows a decreased pressure of approximately 45cm/s as shown by the decreased height of the blood flow graph at the bottom. These quantitative diagnostic technologies are non-invasive allowing close clinical follow-up treatment in diseases affecting the eye related to brain trauma or degenerative neuromuscular disorders.

 

Now that more radiologists are using Doppler blood flow to examine eye disease, including systemic diseases (including diabetes, brain tumors, heart disease, sickle cell disease, etc.) that affect the eye, we are hopeful that the ophthalmologic and neurological communities will start using this noninvasive technology as well to improve noninvasive and more rapid treatment of potential eye disorders, such as cancers of the eye, diabetes and glaucoma.  Another future use will be to correlate the effect of decreased vascular pulsation in the production of cerebrospinal fluid that is removed by the cleansing glymphatic system is postulated as a contributing factor in degenerative neuromuscular disease.   

 

BLOOD FLOW STUDY 101:  Hemodynamics is defined as the study of blood flow in relation to the status of the circulatory system and homeostatic mechanisms of autoregulation.   Through the monitoring of blood flow, diagnostic analysis provides answers to the health and physiological status of the target area scanned as well as cell-level metabolism, regulation of pH, osmotic pressure and protection from microbial and mechanical harm.   Assessing injuries, inflammation or mutative growths by assessment of blood flow allows diagnostic criteria regarding the severity of tissue disorders or tumor malignancy.

 

3D DOPPLER ULTRASOUND: A MAJOR ASSET TO RESEARCH

From simple case studies to double blind clinical trials, the many benefits of non-invasive imaging offers repeatable, visual confirmation of treatment efficacy.  Ultrasound is the most widely used diagnostic technology worldwide and, in particular, 3D Doppler histogram analysis is targeted to collect a patient's biometric data safely and efficiently, thanks to its vastly improved quantitative reporting capacity.

 

Under exploratory device tech reviews, this video shows the effects of electromagnetic pulse wave neuro-stimulation and the induction of improved microcirculation  on the body that are some noninvasive modalities that are easily monitored with an ultrasound scan using Doppler or elastography modalities. In the case of electromagnetic devices, the involuntary muscle contraction is evidence of the electrical changes in the targeted muscle developed by this technology which continues to find new evidence, supporting its ability to recover the body's healing process through cellular regeneration on a preliminary study, quantitative measurement that the regenerative timeline through the use of a neurostimulator through a simple before and after comparison shows the body's reaction to the therapeutic device.

 

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