vision loss in GCA

 Q: 74 years old male is admitted to ICU with a presumed diagnosis of Giant Cell Arteritis (GCA) with vision loss. Pulse steroid is started. Vision loss will probably be? (select one)

A) reversible

B) irreversible

Answer: B

Vision loss in GCA is rarely reversible. Interestingly, patients report improvement in vision. Also, visual acuity tests confirm the improvement. Unfortunately, this is not a true recovery of retinal or optic nerve function. This subjective feeling is due to eccentric compensation for permanent visual deficits.

In any case, to salvage vision, patients should receive  3 days of 500 to 1000 mg of IV methylprednisolone followed by oral prednisone 1 mg/kg/day up to clinician discretion.

#vascular

#rhematology

References:

1. Hayreh SS, Zimmerman B, Kardon RH. Visual improvement with corticosteroid therapy in giant cell arteritis. Report of a large study and review of literature. Acta Ophthalmol Scand 2002; 80:355. 

2. Danesh-Meyer H, Savino PJ, Gamble GG. Poor prognosis of visual outcome after visual loss from giant cell arteritis. Ophthalmology 2005; 112:1098. 

3. Singh AG, Kermani TA, Crowson CS, et al. Visual manifestations in giant cell arteritis: trend over 5 decades in a population-based cohort. J Rheumatol 2015; 42:309. 

4. Hayreh SS, Zimmerman B. Visual deterioration in giant cell arteritis patients while on high doses of corticosteroid therapy. Ophthalmology 2003; 110:1204.