Vision-related quality of life in neuromyelitis optica spectrum disorder: Evidence of subclinical visual dysfunction

Abstract

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a severe inflammatory demyelinating disorder of the central nervous system that frequently results in permanent neurological disability, most commonly due to recurrent transverse myelitis. Although physical and psychological health-related quality of life in NMOSD has been widely studied, the impact of optic neuritis (ON) on vision-related quality of life (VRQoL) remains underreported.

Methods: This multicenter cross- sectional study assessed VRQoL using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in 52 patients: 30 with prior ON (NMOSD+ON) and 22 without (NMOSD−ON). VFQ- 25 scores were analyzed alongside clinical parameters including best-corrected visual acuity (BCVA), disease duration, and ON history.

Results: NMOSD+ON patients were older (median 43 vs. 33 years; p = 0.02), had longer disease duration (8.5 vs. 4.5 years), and lower BCVA (p = 0.002). NEI VFQ-25 composite scores were significantly lower in the NMOSD+ON group (75.7 vs. 98.3), with consistently reduced scores across all subscales (p<0.001). Notably, NMOSD−ON patients demonstrated subtle reductions in general vision, near tasks, and distance activities, suggesting subclinical optic nerve involvement. Multivariate regression analysis identified BCVA of both the better and worse-seeing eyes as independent predictors of VRQoL, irrespective of ON history.

Conclusions: These findings underscore the sensitivity of NEI VFQ-25 as a patient-reported outcome measure for detecting visual compromise in NMOSD, including subtle deficits in patients without clinically overt ON.