Recent evidence suggests that multiple classes are required to enhance fairness, yet it remains unclear how many classes are necessary and what vision tests should be used to define those classes. Paralympic judo currently requires all athletes to compete against each other in one class irrespective of their level of vision impairment (VI). S-cone contrast sensitivity could serve as a sensitive measure of visual impairments associated with early DON in patients with TAO. There is a selective S-cone deficit in the early stage of TAO. The deficit of S-cone was significantly correlated with muscle index in non-DON patients ( R = 0.576, P = 0.001). Our analysis of the ROC curve revealed that the sensitivity to S-cone had the highest index to discriminate non-DON patients from healthy controls (AUC = 0.846, P < 0.001). S-cone contrast sensitivity in non-DON patients was found to be lower than that of healthy controls ( P < 0.001), whereas the sensitivities to L- and M-cone Gabor patches were similar between these two groups ( P = 0.297, 0.666, respectively). We calculated the area under the receiver operating characteristic (ROC) curve to quantify the ability of chromatic contrast sensitivity to detect the early visual function changes in non-DON patients. Isolated L-, M-, and S-cone contrast thresholds were measured at 0.5 cyc/deg using Gabor patches. All observers were tested psychophysically after passing color screening tests and a comprehensive ocular examination. Thirty-two TAO patients without clinical signs of DON (non-DON, 42.03 ± 9.59 years old) and 27 healthy controls (41.46 ± 6.72 years old) participated in this prospective, cross-sectional study. We explored whether thyroid-associated ophthalmopathy (TAO) patients without clinical signs of dysthyroid optic neuropathy (DON) would have a selective deficit mediated by S-cone.
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