Functional and Morphological Changes in the Visual Pathway in Patients with Graves’ Orbitopathy

Round 1

Reviewer 1 Report

In this paper the screening appears comprehensive, however the reader needs to dig out details. In writing “show don’t tell” is a motto to consider, where, the reader should be walked through the data and be shown the conclusions. Most of the paper is a wall of text and tables of means and P values. Graphs may help the user interpret the meaning of each comparison.

P1 L20: PVEP, fVEP, pERG and OCT should be spelled out first use. Rest of intro as well.

Jargon should be avoided through the paper if not defined.

Where is a control normative data, is PERG capable of detecting GO or only determining the severity between 1/2  and group 3? In a study design the comparative groups would expect a cross comparison between all groups and comparison to a control. If there is a compelling reason not to include such data analysis, please state why.

What are the implications of the P100 amplitude and latency changes,

3.1.4 In OCT section a thickness map with red green color scale would normally be expected and help tell the story.

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Reviewer 2 Report

The authors investigated electrophysiological examinations and OCT in GO patients and compared the results in detail with the previous reports.   It is very interesting that there were abnormalities in moderate to severe GO patients that could be considered subclinical, but the following points require major revision.   In Lines 331-333, the authors speculate that the pVEP amplitude reduction in moderate to severe GO patients is due to the same mechanism as in NAION, however, without a detailed MRI evaluation, the cause of the pVEP amplitude reduction in moderate to severe GO patients cannot be clarified.  The MRI of the patients classified as moderate to severe GO in this study should be evaluated in detail. There may be patients in which there is contact of the external ocular muscle to the optic nerve.   Minor revisions are needed on the following points. Line 141: Man-Whitney's t-test to Man-Whitney's u-test.

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Round 2

Reviewer 1 Report

The paper is overall improved by the narrowing of the scope. In this way the data is more concise and digestible to the readers. After final changes to the text are made some proofing is required, but all on the grammatical and formatting aspects.

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Reviewer 2 Report

The authors should describe how many of the 23 patients in Group 2 had MRI or CT. They should also describe how many of them had MRI and how many had CT.

 Even if the PVEP abnormalities in group 2 are due to ischemic changes in the optic nerve, it is not appropriate to compare them to PVEP abnormalities in NAION; they should be compared to those in PION..

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