BACKGROUND Severe residual visual loss (SRVL) is frequent in neuromyelitis optica spectrum disorders (NMOSD). Identifying higher-risk patients at onset is important to prevent disability accumulation. OBJECTIVE To determine predictors of SRVL in a large NMOSD cohort. METHODS Patient characteristics at last visual acuity (VA) evaluation were retrospectively collected. VA was scored 0: better than 20/40, 1: 20/40-20/99, 2: 20/100-20/200, and 3: worse than 20/200. SRVL was defined as a combined score (VA worst + best eye) ⩾ 4. Descriptive statistics were used to compare groups and logistic regression to evaluate predictors of VA. RESULTS 106 patients (mean age at disease onset (AO): 35.8 ± 16.5 years) were included. Patients with SRVL had earlier AO (mean: 26.7 vs 38.0 years) compared to non-SRVL group (p = 0.005). Patients with AO < 21 years were more likely to have SRVL, be blind, present with binocular optic neuritis, have recurrent optic neuritis, and receive oral therapy first-line than those with AO ⩾ 21. After adjusting for race, sex, and disease duration, the odds of SRVL were 4.68 times higher in patients < 21 at disease onset (95% CI: 1.53-14.34, p = 0.007). CONCLUSION Early AO predicts SRVL in NMOSD, independent of disease duration. High-efficacy therapies should be considered for first-line treatment in this group.

中文翻译：

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早期发病可预测视神经脊髓炎谱系障碍患者视力障碍的严重程度

背景严重的残余视力丧失（SRVL）在视神经脊髓炎谱系疾病（NMOSD）中很常见。在发病时识别高危患者对于防止残疾累积很重要。目的 确定大型 NMOSD 队列中 SRVL 的预测因子。方法回顾性收集上次视力（VA）评估时的患者特征。VA 评分为 0：好于 20/40，1：20/40-20/99，2：20/100-20/200，和 3：比 20/200 差。SRVL 被定义为综合评分（VA 最差 + 最佳眼睛）⩾ 4。描述性统计用于比较组和逻辑回归来评估 VA 的预测因子。结果 包括 106 名患者（发病时的平均年龄 (AO)：35.8 ± 16.5 岁）。与非 SRVL 组（p = 0.005）相比，SRVL 患者的 AO 更早（平均：26.7 岁 vs 38.0 岁）。AO<患者 与 AO ⩾ 21 的患者相比，21 岁更可能出现 SRVL、失明、双眼视神经炎、复发性视神经炎和接受一线口服治疗。小于 21 岁的患者在疾病发作时 SRVL 的 SRVL 高 4.68 倍（95% CI：1.53-14.34，p = 0.007）。结论 早期 AO 可预测 NMOSD 中的 SRVL，与疾病持续时间无关。本组应考虑采用高效疗法作为一线治疗。结论 早期 AO 可预测 NMOSD 中的 SRVL，与疾病持续时间无关。本组应考虑采用高效疗法作为一线治疗。结论 早期 AO 可预测 NMOSD 中的 SRVL，与疾病持续时间无关。本组应考虑采用高效疗法作为一线治疗。