For most of us, the phrase "stroke of the eye" sounds like a metaphor. But for UK HealthCare's Jagannadha "Jay" Avasarala, M.D., Ph.D., it's a literal and urgent diagnosis - one that could mean the difference between sight and permanent blindness.
Avasarala's latest study, published in the American Journal of Emergency Medicine, reveals a critical blind spot in how emergency departments (ED) across the globe diagnose a condition known as giant cell arteritis (GCA), which is blood vessel inflammation that can suddenly block blood flow to the eye. The findings show that many patients at or over 50 who arrive in EDs with sudden vision changes are not tested for this potentially blinding disease.
"Every minute counts when it comes to vision loss from GCA," said Avasarala, professor of neurology in the UK College of Medicine. "If the condition isn't recognized and treated immediately, the result can be irreversible blindness. Yet most patients never receive the correct test to diagnose GCA."
A missed diagnosis with high stakes
GCA, sometimes called temporal arteritis, is an autoimmune disorder that causes inflammation of large arteries in the body. The condition frequently causes headaches, scalp tenderness, jaw pain, vision problems, strokes and aortic aneurysms, among others. It most often affects older adults and can lead to serious complications if not diagnosed early.
Using data from the University of Kentucky Medical Center and a nationwide health data platform representing nearly 300 million patients, Avasarala and his team reviewed how often emergency departments tested for GCA in patients with acute vision problems.
The results showed that more than 60% of patients with acute eye symptoms received no testing for GCA and in certain groups, that number climbed as high as 94%. Results also showed that even when testing was done, patients had already been treated with steroids - which can make testing falsely negative. The key is to test early and prior to steroid administration.
Misdiagnosis or a missed diagnosis of GCA can result in blindness that is preventable. Since GCA is linked to aortic diseases, a diagnosis of GCA could also lead to a search for aortic diseases that may be silent.
A simple test that could save sight
The study identified one clear solution: temporal artery ultrasound (TAUS). This quick, noninvasive imaging test can detect inflammation in the arteries - and it can be done right in the ED.
In Avasarala's analysis of more than 700 patients, TAUS was the strongest independent predictor of a correct GCA diagnosis - outperforming the traditional temporal artery biopsy, which is invasive, time-consuming and not performed in real time.
"Ultrasound offers real-time information," said Avasarala. "It's fast, safe and accessible - exactly what we need when every minute matters."
Based on the study, Avasarala believes that integrating TAUS into emergency room protocols could dramatically reduce delays in diagnosis and treatment - preventing blindness in patients who might otherwise lose their vision before ever seeing a specialist.
"By embedding TAUS into ED protocols worldwide, we can bridge the gap between autoimmune disease recognition and acute vascular emergency management," said Avasarala. "This approach reframes GCA not only as a chronic autoimmune disorder, but as an urgent cause of vision-threatening ocular ischemia. Early diagnosis means timely steroids, preserved sight and lives forever changed."
Building a new global model for diagnosis
While this most recent study focuses on improving diagnosis in the ED, Avasarala is already looking ahead to what comes next.
In a companion paper published earlier this year in The Journal of Rheumatology, he and collaborators advocate for the use of artificial intelligence (AI) and cloud-based data systems to make real-time diagnosis of GCA possible anywhere in the world. Using portable, handheld ultrasound devices linked to AI-driven analysis tools, the team envisions a future where clinicians - even in small or rural hospitals - can instantly identify GCA and start sight-saving treatment.
"Blindness from this disease is preventable," Avasarala said. "We have the technology. Now we need to bring it to where the patients are - whether that's in an emergency room, an ambulance or a rural clinic."
A call to action
Avasarala's work reframes GCA as a stroke-equivalent emergency. The research suggests that, just as hospitals now follow "Get With The Guidelines" protocols for stroke, similar standardized pathways should be created for GCA.
"If we can diagnose a cerebrovascular stroke in real time, we can diagnose a stroke of the eye the same way," said Avasarala. "No one should lose their vision when the tools to prevent it are right in front of us."
