Background/Purpose: Permanent vision loss (PVL) is a feared complication and a leading cause of morbidity in Giant Cell Arteritis (GCA). Multiple risk factors for ocular involvement have been identified with variable consistency, including older age, male sex, presence of cardio-vascular risk factors, transient ischemic symptoms, jaw claudication and thrombocytosis. The objective of this study is to describe visual manifestations and identify risk factors that predict ocular involvement in patients with GCA.

Methods: The retrospective database, CAPHECO-GCA (Characteristics, Phenotype, Evolution and Complications of patients with GCA at Hopital du Sacre-Coeur de Montreal) was used to collect data between January 1^st, 2000 and December 31^st, 2019. The presence of GCA was based on the treating physician’s diagnosis and confirmed retrospectively by a separate GCA expert. Descriptive statistics comparing patients with and without visual symptoms and PVL were performed. Funding for the creation of the CAPHECO-GCA database was provided by CanVasc (Canadian Network for Research on Vasculitides).

Results: A total of 100 patients with GCA were included. Of these, 95 patients met the 1990 ACR classification criteria for GCA, and 53 patients had visual symptoms. Visual symptoms included blurred vision (30% of patients), diplopia (16% of patients), amaurosis fugax (14% of patients) and blindness (19% of patients). Out of the 19 patients with blindness, 16 did not recuperate and had PVL. Patients with PVL were older (79,2 ± 6,7 vs 74,2 ± 7,6 years; p = 0,008), more likely to have coronary artery disease (31% vs 10%; p = 0,018) and peripheral artery disease (19% vs 5%; p = 0,044) than patients without PVL. However, patients with PVL were less likely to have other cranial symptoms (81% vs 96%; p = 0,019), mainly headaches (64% vs 92%; p= 0,003). A total of 58 patients underwent ophthalmologic examination: 10 patients had anterior ischemic optic neuropathy, 3 patients had central retinal artery occlusion, 1 patient had branch retinal artery occlusion and 3 patients had cranial nerve palsy. Risk factors associated with an abnormal ophthalmologic examination were the same as for PVL, but patients were also more likely to have diabetes (29% vs 7%; p = 0,026) and less likely to have constitutional symptoms (53% vs 80%; p = 0,033). Presence of visual symptoms was associated with a lower mean C-reactive protein level (73,7 ± 59,3 vs 104,3 ± 80,3 mg/L; p = 0,035). There was no statistically significant difference for sex, prior eye disease, delay to presentation, polymyalgia rheumatica, abnormal temporal artery on physical examination, extra-cranial large vessel vasculitis and platelet count.

Conclusion: Patients with GCA and PVL and/or abnormal ophthalmologic examination were older and more likely to have baseline diabetes, coronary artery disease and peripheral artery disease. A predisposing vascular vulnerability might therefore increase the risk of ocular involvement in GCA.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/characterization-of-visual-manifestations-and-identification-of-risk-factors-for-permanent-vision-loss-in-patients-with-giant-cell-arteritis/