Visual fields in giant cell arteritis (Horton’s disease)

BackgroundThe purpose of this study was to investigate visual field defects in different clinical presentations of giant cell arteritis.MethodologyRetrospective study of 36 patients from 1996–2010 with giant cell arteritis (67% female, average age 79, range 62–92 years), with typical clinical picture and/or positive biopsy (78%, 18/23 performed). Visual fields charted by Goldmann perimeter were categorized into specific categories. Respect for horizontal meridian was noted.ResultsLoss of vision was unilateral (65%) or bilateral (35%). The most common ischaemic lesions were anterior ischaemic optic neuropathy (AION; 16 unilateral, 4 bilateral) and posterior ischaemic optic neuropathy (PION; 5 unilateral, 5 bilateral). Other lesions included central retinal artery occlusion (CRAO) and internuclear ophthalmoplegia (INO). More than half of the affected eyes (53%) had visual acuity of counting fingers to no light perception. We observed 11 types of visual field defects. AION presented most commonly with peripheral island (35%) and sector defect (35%). Inferior altitudinal defect occurred in 18%. There was a tendency to affect nasal and inferior halves of visual fields. PION occurred in 31% of patients and most often presented with scotoma with or without peripheral defect.ConclusionsAION most commonly presented with peripheral island (35%) or sector defect (35%). Visual field defects in AION almost universally showed respect for horizontal meridian, except where only small residual island remained. Inferior altitudinal defect occurred less commonly than expected (18%). PION was more prevalent in our study (31%) compared to others and most often presented with scotoma with or without peripheral defect.

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