Factors associated with poor visual outcome in patients with MOG antibody-associated optic neuritis

Background Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) is a major phenotype of MOG antibody-associated disease. Although visual recovery is generally favorable, some patients develop persistent visual dysfunction. We evaluated the frequency of poor visual outcome and associated clinical factors in adults with MOG-ON. Methods This study retrospectively reviewed adult MOG-ON patients who were treated at the Chinese PLA General Hospital between May 2018 and May 2024. Of 178 patients screened, 91 were included in the analysis. Visual outcome at the final follow-up was classified as good (Visual Functional System Score [VFSS] ≤2) or poor (VFSS ≥3). Factors associated with poor outcomes were examined using univariable and multivariable logistic regression. Results Of 91 patients, 27 (29.67%) had poor visual outcome. The median age at onset was 35.00 years (interquartile range, 29.00–49.50), and 61 patients (67.03%) were women. Patients with poor outcomes had a longer interval from symptom onset to treatment after the first attack (median, 18.00 vs 10.00 days; P<0.001) and a higher annualized relapse rate (ARR) during follow-up (median, 1.00 vs 0.23; P = 0.019). Both treatment delay (odds ratio [OR] per day, 1.10; 95% confidence interval [CI], 1.03–1.18; P = 0.007) and higher ARR (OR, 2.50; 95% CI, 1.25–4.99; P = 0.010) were associated with poor final visual status in multivariable analysis. Conclusions Nearly one-third of adults with MOG-ON had poor visual outcome at the final follow-up. Delayed treatment initiation after the first attack and greater relapse burden during follow-up were associated with poor final visual status. Prospective multicenter studies are warranted.