Neuro-Ophthalmic Literature Review

Neuro-Ophthalmic Literature Review David Bellows, Noel Chan, John Chen, Hui-Chen Cheng, Peter MacIntosh, Jenny Nij Bijvank, Michael Vaphiades, Konrad Weber, and Sui Wong “It don’t matter if you’re Black or White” Gruener AM, Poostchi A, Carey AR, Eberhart CG, Henderson AD, Chang JR, McCulley TJ. Association of giant cell arteritis with race. JAMA Ophthalmol. 2019 Aug 8. Giant cell arteritis (GCA) has widely been considered a rare disorder in black patients. In this retrospective study, the authors reviewed the charts of all patients who underwent temporal artery biopsy over a 10-year period (2007 through 2017) at Johns Hopkins School of Medicine. It should be noted that the population of Baltimore is more than 60% black and the patient population at Johns Hopkins is approximately 40% black. For the purposes of this study, a patient’s race was determined by their self-identified race in the electronic medical record. Additionally, only patients over the age of 50 were included to avoid controversy surrounding the diagnosis of giant cell arteritis in younger individuals. A total of 586 patients were identified who had undergone temporal artery biopsy during the study period. Among these patients, 65.2% were white and 28.5% were black. Biopsies that demonstrated active or healed arteritis were considered positive. Using these criteria, 16.1% of the patients were considered to have biopsy-proven giant cell arteritis (BP-GCA); 14 were black (8.4% of all black patients tested) and 75 were white (19.6% of all white patients tested). This translates to a population-adjusted rate of GCA to be 3.1 in blacks and 3.6 in whites per 100,000. The mean age of patients with BP-GCA was similar between the two groups (74.1 years for whites and 75.4 years for blacks) which is consistent with previous reports. Giant cell arteritis has long been thought to have a much greater incidence in whites than in blacks. This widely held belief may cause the clinician to have a higher threshold for obtaining temporal artery biopsy in black patients. In this study, the authors have clearly contradicted that belief. They emphasise the fact that we should have a similar threshold for obtaining temporal artery biopsy regardless of the patient’s race.