To evaluate the ophthalmic presentation and visual outcome for patients with giant cell arteritis (GCA).

GCA is one of the leading causes of irreversible blindness in neuro-ophthalmology.

A single center, retrospective cohort study was conducted by querying for ICD-10 code M31.6 in the electronic medical records between September 2013 to September 2023. The demographics, best-corrected visual acuity (BCVA), color perception (% correct), retinal nerve fiber layer (RNFL), ganglion cell complex layer (GCC), and Humphrey visual fields (HVF) 24-2 score were collected. Patients were grouped into no ocular involvement (OI), mild OI (transient vision loss, diplopia, partial optic disc pallor with mild HVF defects) or severe OI (ocular ischemic syndromes, optic disc pallor with severe HVF defects or BCVA <20/40).

215 patients were identified (37 TAB confirmed GCA, F=65%, age= 72, and 26 had at least one ophthalmic exam). By 3 months after diagnosis, when comparing no to mild OI, ophthalmic parameters showed BCVA (20/26 vs. 20/32, p=0.15), color (87% vs. 82%, p=0.60), RNFL (96mm vs. 87mm, p=0.02), GCC (74mm vs. 75mm, p=0.60), and HVF (-0.05 vs. -1.64, p=0.11). When comparing no with severe OI, the severe group demonstrated BCVA (20/993, p=0.0001), color (6%, p<0.0001), RNFL (86mm, p=0.60), GCC (60mm, p=0.02), and HVF (-17.85, p=0.02). By 12 months or more after diagnosis, when comparing no to mild OI, ophthalmic parameters showed BCVA (20/29 vs. 20/27, p=0.26), color (100% vs. 87%, p=0.006), RNFL (93mm vs. 87mm, p=0.01), GCC (76mm vs. 75mm, p=0.47), and HVF (-2.58 vs. -1.65, p=0.37). When comparing no with severe OI, the severe group showed BCVA (20/366, p=0.0002), color (30%, p<0.0001), RNFL (56mm, p<0.0001), GCC (52mm, p<0.0001), and HVF -19.18, p<0.0001).

GCA patients with severe OI showed significant decline in all ophthalmic parameters overtime, while the mild OI group demonstrated a notable decline specifically in RNFL thickness.