Clinical Spectrum of Neuro-Ophthalmic Disorders at a Thai Tertiary Referral Center: An 11-Year Retrospective Study.

Abstract

Purpose: To characterize the diagnostic spectrum of a tertiary neuro-ophthalmology service in Thailand and to describe the etiologic distribution of selected H47-coded optic nerve and optic disc records after chart-based adjudication.

Patients and methods: We conducted a retrospective service-based study of outpatient (OPD) and inpatient (IPD) neuro-ophthalmic records from January 2015 through December 2025. Analyses distinguished unique individuals, setting-specific patient-year records, patient-year-category records, and individual diagnostic records. H46-coded optic neuritis records were retained as code-based diagnoses; selected H47-coded records underwent manual chart adjudication by a fellowship-trained neuro-ophthalmologist using prespecified criteria. Annual analyses combined OPD and IPD after same-person/same-year cross-setting deduplication.

Results: The dataset contained 1533 OPD and 504 IPD setting-specific patient-year records, representing 1815 unique individuals overall and 1905 cross-setting patient-years. Optic nerve and optic disc disorders occurred in 769/1,533 OPD patient-years (50.2%; 95% CI, 47.7-52.7) and 302/504 IPD patient-years (59.9%; 95% CI, 55.6-64.1). At the diagnostic-record level, 1076 optic nerve/disc records were identified: 344 H46-coded optic neuritis records and 732 selected H47-coded records with chart-based final classification. The most frequent diagnostic records were optic neuritis (344, 32.0%), optic atrophy/optic neuropathy NOS (230, 21.4%), ischemic optic neuropathy (111, 10.3%), optic disc cupping/glaucoma suspect (102, 9.5%), traumatic optic neuropathy (94, 8.7%), and compressive optic neuropathy (76, 7.1%). Optic nerve/disc disorders were the numerically largest category in every study year, accounting for 47.2%-58.3% of annual cross-setting patient-years.

Conclusion: In this single-center service-based dataset, optic nerve and optic disc diagnoses were the most frequently recorded neuro-ophthalmic category. Manual chart review of selected H47-coded records enabled more detailed etiologic grouping, while H46-coded optic neuritis remained a code-based subgroup. The findings describe local tertiary referral practice and should be externally validated before generalizing the classification approach across institutions.