• SmithSonja C MansfieldSCMNorfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK., Mustafa R Al-Hashimi, Colin D Jones, and Chetan B Mukhtyar.
• Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
• Clin Med (Lond). 2023 May 1; 23 (3): 206212206-212.

BackgroundWe present the largest study of the frequency and nature of visual complications in a cohort of 350 patients consecutively diagnosed with giant cell arteritis (GCA).MethodsAll individuals were assessed using structured forms and diagnosed using imaging or biopsy. A binary logistic regression model was used to analyse data for predicting visual loss.ResultsVisual symptoms occurred in 101 (28.9%) patients, with visual loss in one or both eyes in 48 (13.7%) patients. Four patients had binocular visual loss. Anterior ischaemic optic neuropathy (N=31), retinal artery obstruction (N=8) and occipital stroke (N=2) were the main causes of visual loss. Of the 47 individuals who had repeat visual acuity testing at 7 days, three individuals had improvement to 6/9 or better. After introducing the fast-track pathway, the frequency of visual loss decreased from 18.7% to 11.5%. Age at diagnosis (odds ratio (OR) 1.12) and headache (OR 0.22) were significant determinants of visual loss in a multivariate model. Jaw claudication trended to significance (OR 1.96, p=0.054).ConclusionsWe recorded a visual loss frequency of 13.7% in the largest cohort of patients with GCA examined from a single centre. Although improvement in vision was rare, a dedicated fast-track pathway reduced visual loss. Headache could result in earlier diagnosis and protect against visual loss.© Royal College of Physicians 2023. All rights reserved.

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