2025 American Academy of Neurology Abstract Website

Objective:

This study investigates visual outcomes and treatment responses in giant cell arteritis (GCA) patients.

Background:

Ophthalmic imaging is an underutilized tool that can contribute to the early diagnosis and treatment of GCA.

Design/Methods:

We reviewed GCA patients' neuro-ophthalmology visits at a tertiary center during June 2018-September 2023. Assessments included best-corrected visual acuity (BCVA), Humphrey visual fields (HVF) 24-2, color plates (%color), and pupil exams. Optical coherence tomography measured the thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), microvascular density of the inner retina (ILM-IPL) and outer retina (IPL-OPL), and foveal vascular zone (FAZ). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded. Patients were grouped based on temporal artery biopsy results into positive biopsy (TAB+) or clinically diagnosed (CD), and visual involvement (VI and NVI) at diagnosis.

Results:

219 visits from 25 patients (146 TAB+, 73 CD eyes) were included. All initially received high-dose steroids. Only two experienced visual relapses.

0-6 months:

TAB+ differences between VI and NVI included BCVA (20/90 vs 20/26, p<0.001), %color (56.72% vs. 85.30%, p=0.021), HVF mean deviation (-16.73 vs. -1.90, p<0.001), GC-IPL (59.27 vs. 78.35, p<0.001), ILM-IPL (40.19 vs. 46.28, p=0.044). In CD, differences included CRP (2.60 vs. 1.12, p=0.040), RNFL (76.32 vs. 103, p<0.001), GC-IPL (65.84 vs. 90.50, p<0.001), RPC (40.81 vs. 47.41, p=0.024).

6-12 months:

TAB+ showed differences in BCVA (20/139 vs. 20/26, p=0.006), %color (25.0 vs. 88.39, p=0.001), HVF MD (-17.23 vs. -1.58, p<0.001), RNFL (71.31 vs. 93.17, p<0.001), GC-IPL (54.12 vs. 71.70, p<0.001), RPC (37.33 vs. 48.52, p=0.003), ILM-IPL (39.10 vs. 47.85, p=0.005). CD differences were CRP (0.15 vs. 1.66, p<0.001), RNFL (75.41 vs. 105.66, p<0.001), GC-IPL (62.07 vs. 85.66, p=0.003), RPC (37.40 vs. 47.75, p=0.008).

Conclusions:

GCA patients with VI, particularly those TAB+, had poorer visual prognosis, highlighting the need for early neuro-ophthalmological assessment in GCA patients.