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Julie M. Schallhorn, Sara J. Haug, Michael K. Yoon, Travis Porco, Stuart R. Seiff, Timothy J. McCulley; A National Survey of Practice Patterns: Unilateral Versus Bilateral Temporal Artery Biopsy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4283.
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This study is designed to assess the current clinical practice patterns among oculoplastic surgeons, neuro-ophthalmologists and rheumatologists with regard to unilateral versus bilateral temporal artery biopsy for giant cell arteritis.
A survey was sent via e-mail to the members and affiliates of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), the North American Neuro-Ophthalmology Society (NANOS), and the American College of Rheumatology (ACR) using the Survey Monkey website (surveymonkey.com). All responses were anonymous, no identifying information was acquired. Data analysis was performed using Fisher’s exact test or Wilcox rank sum test as appropriate.
Self described primary sub-specialty of the 649 respondents were as follows: oculoplastic surgery (n=129), neuro-ophthalmology (n=120), both oculoplastic surgery and neuro-ophthalmology (n=14), rheumatology (n=380) and other (n=6). Among the respondents, some (n=301) perform TAB whereas others do not perform the surgery themselves but do refer patients for biopsy (n=344). Overall 65% (n=424) advocated initial unilateral TAB, 16% (n=105) advocated bilateral biopsy in all cases and the remainder (14%, n=92) recommended either unilateral or bilateral TAB depending on the degree of clinical suspicion. Of those that advocated initial unilateral TAB, opinions were split as to whether they would (n=162, 42%) or would not (n=224, 58%) advocate biopsy on the fellow side. Twenty-two percent (n=86) of rheumatologists advocate bilateral biopsy initially, as opposed to 11% of neuro-ophthalmologists (n=14) and 8% of oculoplastic surgeons (n=10), this difference was statistically significant (p<0.0001). Once one side had been biopsied, both rheumatologists (n = 126, 46%, p=0.05) and neuro-ophthalmologists (n=40, 49%, p<0.05) were more likely to advocate biopsy of the second side than oculoplastic surgeons (n=28, 33%).
Temporal artery biopsy practices vary greatly between neuro-ophthalmologists, oculoplastic surgeons, and rheumatologists. This lack of consensus underscores the need for a systematic assessment of our varying practice patterns.
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