Graves’ Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management

Table 1

NO SPECS modified classification [22].

Class	Grade	Suggestions for grading
0		No physical signs or symptoms
I		Only signs
II		Soft tissue involvement
	0	Absent
	a	Minimal
	b	Moderate
	c	Marked
III		Proptosis (3 mm or more of normal upper limits with or without symptoms)
	0	Absent
	a	3 or 4 mm over upper normal
	b	5 to 7 mm increase
	c	8 mm increase
IV		Extraocular muscle involvement (usually with diplopia)
	0	Absent
	a	Limitation of motion at extremes of gaze
	b	Evident restriction of motion
	c	Fixation of a globe or globes
V		Corneal involvement (primarily due to lagophthalmos)
	0	Absent
	a	Stippling of cornea
	b	Ulceration
	c	Clouding, necrosis, and perforation
VI		Sight loss (due to optic nerve involvement)
	0	Absent
	a	Disc pallor or choking, or visual field defect, vision 20/20–20/60
	b	The same, but vision 20/70–20/200
	c	Blidness, vision less than 20/200