Clinical VISA Forms

The ITEDS-VISA Classification was developed in Vancouver and is a clinical recording form designed for office use which allows both grading and recording of TED disease severity and activity (progression) based on both subjective and objective inputs to help plan management.

The severity of the disease is defined by separating the clinical features of TED into four severity parameters:

V   (vision, optic neuropathy)

I    (inflammation, congestion)

 (strabismus, motility restriction)

A   (appearance, exposure).

ITEDS has modified these recording forms by consensus of its members and adopted them as their standardized office record.

The basic layout includes the four sections recording historical symptoms on the left and signs on the right. After each section is a progress row (better, same, worse = s,b,w), recording both the patient’s and clinician’s impression of the course of the disease since the last visit. This allows the determination of the disease phase:  active (progressive) or inactive (quiescent).

The layout is designed to simplify data recording and possible later research data collation. Individual measurements may be completed in as much or as little detail as the clinician chooses.  At the end of the form is a summary grade for the activity and severity for each of the four disease parameters and space for investigations and the management plan.  Click on image to the right to see a magnified form.

On the first visit, the date and rate of onset and historic progression of both the systemic and orbital symptoms are recorded, defining characteristics of the disease course.  Additional questions also determine risk factors for a more severe disease outcome associated with extraocular muscle involvement, including smoking, family history, and diabetes.

Copies of the two-page initial visit form and the single-page follow-up form may be downloaded in word format for office use through the buttons below.