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

Abstract

Background: The purpose of this study was to investigate visual field defects in different clinical presentations of giant cell arteritis. Methodology: Retrospective 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. Results: Loss 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. Conclusions: AION 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. © 2011 Versita Warsaw and Springer-Verlag Wien.