Characterizing the Role of Ophthalmologists in the Care of Patients With Suspected Giant Cell Arteritis at an Academic Medical Center

BACKGROUND: Evaluation and treatment of giant cell arteritis (GCA) is multidisciplinary, with high morbidity if not promptly treated. Ophthalmologists may be involved due to the presence of visual symptoms and/or ischemic vision loss. The goal of this study was to characterize the health care journey of patients suspected of having GCA and elucidate the role that ophthalmologists and other specialists play in their prebiopsy evaluation. METHODS: This retrospective study included patients at a single large academic institution who underwent a temporal artery biopsy (TAB) as part of a GCA evaluation over a 10-year period. Demographics, symptoms, laboratory testing, ancillary imaging, treatment initiation, biopsy results, and final diagnosis were extracted from the medical record. Types of specialists involved in different aspects of the prebiopsy evaluation for GCA were tabulated. A Sankey plot was created to visualize the included patients' journeys. RESULTS: Among 162 subjects undergoing TAB (average age of 74 years SD 11.3, 64.8% female, 60% ocular symptoms), 43 were diagnosed with GCA (30 positive TAB). Subjects saw an average of 3.31 providers (SD 1.15) from different specialties during their prebiopsy evaluation, with multiple patients seeing 6 different specialists. Within our cohort, 51% (n = 83) of patients saw ophthalmologists before TAB and 33% (n = 53) had their TAB performed by an ophthalmologist. Seeing an ophthalmologist during the prebiopsy period was not associated with a positive biopsy result (P = 0.80) or prebiopsy steroid treatment for GCA (P = 0.90). CONCLUSIONS: GCA suspects have a convoluted journey through our health care system and are commonly seen by multiple medical subspecialists during their evaluation. This may benefit patients due to multiple expert perspectives or may contribute to fragmentation of care and delays in treatment. These results reinforce the number of subspecialists, including ophthalmologists, who play a role in the evaluation of GCA. Multidisciplinary fast-track GCA clinics can both provide access to subspeciality care and simplify the patient journey.