Giant cell arteritis (GCA) is a potentially blinding disease caused by inflammation involving large to medium sized blood vessels which if untreated can progress to severe vision loss and blindness in both eyes due to involvement of the blood vessels that can affect the optic nerve and/or retina.
GCA is the most common form of vasculitis in patients 50 years of age and older. It is the most frequent – and feared – cause of arteritic anterior ischemic optic neuropathy (A-AION). If GCA goes undiagnosed or is left untreated, it can rapidly lead to profound, irreversible vision loss in both eyes. When GCA treatment is initiated after vision is lost in one eye, the likelihood of devastating vision loss in the second eye can be markedly reduced.
GCA often, but not always, causes one or more of the following symptoms, in addition to vision disturbances: new onset headache; scalp tenderness; neck tenderness; tenderness in the temple area; jaw claudication (pain in the cheek muscles when chewing); pain and stiffness in the shoulder and hip muscles; night sweats; unintentional weight loss.
HOW CAN OPTOMETRISTS AND OPHTHALMOLOGISTS DIAGNOSE GCA?
An optometrist is a healthcare professional who provides primary eye care services, focusing on vision testing, prescribing corrective lenses, and detecting common eye conditions. They do not perform surgeries. An ophthalmologist is a medical doctor who specializes in eye care, including diagnosing and treating eye diseases, performing surgeries, and managing complex eye conditions. They have a broader scope of practice and can provide both medical and surgical interventions. Both are trained to diagnose and treat (or guide treatment for) eye-related conditions, including GCA. The process taken to diagnose GCA may involve the following steps:
- Medical history: The medical provider may take a detailed medical history of the patient, which includes symptoms such as sudden vision loss, headache, scalp tenderness, jaw claudication, and fatigue. They will also ask about any past medical conditions or surgeries that the patient has undergone.
- Physical/visual examination: The medical provider may perform a physical examination of the patient, which may include checking visual acuity, intraocular pressure, and pupillary reactions. The optometrist will also examine the eyes for signs of inflammation, such as redness, swelling, and pain. Should signs of inflammation be visible, the medical provider may refer the patient to a higher acuity of care of order confirmatory tests.
- Temporal artery biopsy: The ophthalmologist may perform a temporal artery biopsy, which involves taking a small sample of tissue from the temporal artery, which is located on the side of the head. The tissue sample is then examined under a microscope to check for signs of inflammation and damage to the blood vessels.
- Blood tests: The ophthalmologist may also order a series of blood tests, which include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) tests and platelet. These tests help to measure the level of inflammation in the body, which can be an indication of GCA. Unfortunately, none of these tests, individually or in combination, can be used to definitively eliminate the diagnosis of giant cell arteritis but only to establish the likelihood or risk of giant cell arteritis
- Imaging tests: The ophthalmologist may also order imaging tests, such as a magnetic resonance imaging (MRI) or computed tomography (CT) scan, to check for any damage to the blood vessels or other structures in the eye and to check for presence of chalky white disc swelling along with retinal involvement.
WHAT IS THE TREATMENT FOR GCA?
When GCA is suspected, high does intravenous steroids should be started immediately along with ordering a temporal artery biopsy to secure the diagnosis. Treatment of suspected GCA should not be delayed until the biopsy can be performed. Failure to promptly treat the patient with steroids could lead to profound bilateral visual loss. Other treatments may include:
- Immunosuppressant drugs: In some cases, immunosuppressant drugs may be used in combination with corticosteroids to reduce the risk of relapse and to help taper off corticosteroids.
- Aspirin: Low-dose aspirin may be prescribed to reduce the risk of blood clots and complications such as stroke.
- Eye drops: Eye drops may be prescribed to relieve symptoms such as eye pain, redness, and inflammation.
- Calcium and Vitamin D supplements: Long-term use of corticosteroids can lead to bone loss, so calcium and vitamin D supplements may be recommended to prevent osteoporosis.
- Regular follow-up: Patients with GCA require regular follow-up with their optometrist, ophthalmologist, and rheumatologist to monitor their symptoms and treatment response. Blood tests may also be done to monitor the disease activity and potential side effects of medications.
It is important to note that the treatment plan for GCA may vary depending on the patient’s individual needs and the severity of the disease.
FRIEDMAN SCHUMAN GIANT CELL ARTERITIS CASE STUDY:
Friedman Schuman has been retained to investigate multiple cases involving a failure to timely diagnose and treat Giant Cell Arteritis. One such case is detailed below:
* The name of the client has been changed to protect their privacy. *
In September 2020, Jane Doe, a 60+ year old woman, visited her optometrist for an examination of her right eye due to blurry vision. She was also experiencing tooth and jaw discomfort (“jaw claudication”). Images were taken at the office which showed swelling around in the optic disc of her right eye. This information was not relayed to patient.
Instead, Jane Doe left her eye appointment with updated glasses and contacts and was told to return in one year for an annual appointment. Over the next few days, the pain in her mouth and jaw continued, prompting her to see her endodontist. Jane Doe was that there was no oral issue and was advised to go back to her eye doctor. That same day, Jane Doe went back to her optometrist, who took additional imaging, which revealed profound edema/swelling of the optic nerve. Jane Doe was advised to go to the ER and have the doctors rule out Giant Cell Arteritis (GCA).
Jane Doe went to Emergency Department where she was regrettably not seen by ophthalmology and was instead referred to a neuro-ophthalmologist the following day. Overnight, her vision continued to worsen.
The following day, the neuro-ophthalmologist told Jane to take aspirin and advised that he had observed that her optic disc appeared “unusual”, but that there was nothing to worry about with respect to the other eye. No biopsies were taken, nor were any steroids administered or prescribed.
Over the course of the next few days, Jane Doe continued to follow medical direction.
Approximately a week later, Jane Doe awoke with loss of vision in her left eye. She spoke directly with the on-call resident, who told her that she could be seen the following day, Monday, but that it was unlikely that the situation would get worse. Concerned, Jane Doe’s family also called the on-call resident to inquire whether any consideration was given to a diagnosis of GCA, or at a minimum, whether steroids would be initiated The on-call doctor responded by offering to write a script for steroids and suggesting that the patient be seen the next day.
Jane Doe decided to go to another Emergency Department that afternoon, at her family’s suggestion. Jane Doe was given intravenous steroids immediately while labs were pending and was admitted. Predictably, the results confirmed GCA.
Due to the delay in initiating therapy, Jane Doe’s bilateral blindness was deemed irreversible.
The Friedman Schuman medical malpractice attorneys filed suit on behalf of Jane Doe and her husband, and quickly obtained a confidential seven figure settlement.
MY GIANT CELL ARTERITIS DIAGNOSIS WAS DELAYED DUE TO NEGLIGENCE, WHAT DO I DO?
If you or a loved one has experienced symptoms of Giant Cell Arteritis and received a delayed diagnosis due to the negligence of medical professionals administering your care, our legal team is dedicated to helping you seek the justice you deserve. Our team of caring and skilled medical malpractice attorneys have helped hundreds of clients navigate the litigation process following a delayed or misdiagnosis. Contact our medical malpractice attorneys today for a complimentary consultation regarding your case.