{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T09:57:39Z","timestamp":1763114259795,"version":"3.45.0"},"reference-count":44,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Background\/Objectives: Optic neuropathies (ON) are a clinically heterogeneous group of disorders that can cause profound and lasting visual disability, with wide-ranging effects on patients\u2019 quality of life. Although the NEI-VFQ-25 is an instrument for assessing vision-related quality of life (VRQoL), few studies have systematically compared patient-reported outcomes across multiple ON subtypes, especially in underrepresented populations. We aimed to delineate how etiological differences and longitudinal visual acuity trajectories shape VRQoL in a diverse Portuguese cohort with ON. Methods: This retrospective, cross-sectional study included 152 patients diagnosed with ON and followed at S\u00e3o Jo\u00e3o University Hospital, Portugal. All participants completed the validated NEI-VFQ-25. Diagnosis-specific differences in VRQoL were interrogated using ANCOVA and linear mixed-effects models, controlling for age and sex. Visual acuity changes over time were analyzed in relation to patient-reported outcomes. Results: Substantial heterogeneity in VRQoL was observed across ON subtypes. Patients with MS-related ON (MS-RON) and idiopathic ON reported significantly higher NEI-VFQ-25 scores in domains such as general vision, mental health, and dependency (F = 3.30, p = 0.013; \u03b7p2 = 0.08), while those with ischemic or other inflammatory etiologies showed persistently lower scores. Notably, both final visual acuity and diagnosis were independently associated with NEI-VFQ-25 composite scores, highlighting the correlation between objective and subjective measures of visual function. Age and diagnosis independently predicted poorer VRQoL. Conclusions: This study provides the first comprehensive evaluation of vision-related quality of life (VRQoL) across a diverse cohort of optic neuropathy patients in a Portuguese tertiary center, using the NEI-VFQ-25. Our results underscore the heterogeneity of functional impact across ON subtypes, emphasizing the value of integrating sensitive, multidimensional assessment tools into neuro-ophthalmic clinical care, especially in populations historically underrepresented in research.<\/jats:p>","DOI":"10.3390\/neurolint17110184","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T10:56:27Z","timestamp":1762858587000},"page":"184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vision-Related Quality of Life in Patients with Optic Neuropathy: Insights from a Portuguese Single Center Using the NEI-VFQ-25"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7041-5848","authenticated-orcid":false,"given":"Sofia","family":"Bezerra","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6878-8568","authenticated-orcid":false,"given":"Ricardo","family":"Soares dos Reis","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Department of Neurology, S\u00e3o Jo\u00e3o University Hospital, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0825-2977","authenticated-orcid":false,"given":"Maria Jos\u00e9","family":"S\u00e1","sequence":"additional","affiliation":[{"name":"School of Medicine and Biomedical Sciences, University Fernando Pessoa, 4249-004 Porto, Portugal"},{"name":"RISE-Health, Faculty of Health Sciences, FP-BHS, FP-I3ID, University Fernando Pessoa, 4249-004 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1540-1395","authenticated-orcid":false,"given":"Joana","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Department of Neurology, S\u00e3o Jo\u00e3o University Hospital, 4200-319 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/S1474-4422(22)00334-9","article-title":"A new classification for diagnosis of optic neuritis","volume":"21","author":"Galetta","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1177\/11206721211028050","article-title":"Optic neuritis classification in 2021","volume":"32","author":"Ducloyer","year":"2021","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1016\/S1474-4422(22)00200-9","article-title":"Diagnosis and classification of optic neuritis","volume":"21","author":"Petzold","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3097","DOI":"10.1038\/s41433-023-02478-z","article-title":"Evaluating patient-reported outcome measures (PROMs) for future clinical trials in adult patients with optic neuritis","volume":"37","author":"Panthagani","year":"2023","journal-title":"Eye"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.msard.2016.11.008","article-title":"Severe structural and functional visual system damage leads to profound loss of vision-related quality of life in patients with neuromyelitis optica spectrum disorders","volume":"11","author":"Schmidt","year":"2017","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4229","DOI":"10.2147\/OPTH.S258783","article-title":"Visual Impairment and Mental Health: Unmet Needs and Treatment Options","volume":"14","author":"Demmin","year":"2020","journal-title":"Clin. Ophthalmol."},{"key":"ref_7","first-page":"19","article-title":"Peripheral visual field loss and activities of daily living","volume":"36","author":"Gagrani","year":"2022","journal-title":"Curr. Opin. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1001\/archopht.116.11.1496","article-title":"Psychometric Properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ)","volume":"116","author":"Mangione","year":"1998","journal-title":"Arch. Ophthalmol."},{"key":"ref_9","first-page":"1050","article-title":"Development of the 25-Item National Eye Institute Visual Function Questionnaire","volume":"119","author":"Mangione","year":"2001","journal-title":"JAMA Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1167\/tvst.11.5.10","article-title":"The NEI VFQ-25C: Calibrating Items in the National Eye Institute Visual Function Questionnaire-25 to Enable Comparison of Outcome Measures","volume":"11","author":"Goldstein","year":"2022","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1001\/jamaophthalmol.2021.0146","article-title":"A Global Assessment of Eye Health and Quality of Life: A Systematic Review of Systematic Reviews","volume":"139","author":"Assi","year":"2021","journal-title":"JAMA Ophthalmol."},{"key":"ref_12","first-page":"239","article-title":"Psychometric Properties of Scales for Assessing the Vision-related Quality of Life of People with Low Vision: A Systematic Review","volume":"30","author":"Posada","year":"2022","journal-title":"Ophthalmic Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s10792-024-02916-1","article-title":"Vision-related quality of life in patients with retinal vein occlusion","volume":"44","author":"Ramin","year":"2024","journal-title":"Int. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Silva, M.S.F., Arantes, T.E., Moreto, R., Smith, J.R., and Furtado, J.M. (2023). Vision-related quality of life in patients treated for ocular syphilis. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-40289-0"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/brain\/awu335","article-title":"Vision and vision-related outcome measures in multiple sclerosis","volume":"138","author":"Balcer","year":"2015","journal-title":"Brain"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Jiang, Z., Qian, H., and Wei, S. (2022). Vision-related quality of life in patients with atypical optic neuritis. Front. Pain Res., 3.","DOI":"10.3389\/fpain.2022.871269"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gassan, A.A., Konig, A., Nisenbaum, R., Freedman, M.S., Lee, L., Marrie, R.A., McCombe, J.A., Micieli, J., Morrow, S.A., and Parks, N.E. (2025). Comparison of vision-related quality of life in NMOSD and MOGAD. Mult. Scler. Relat. Disord., 97.","DOI":"10.1016\/j.msard.2025.106392"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Song, R., Huang, W., Yang, J., Tang, X., Huang, Y., Chen, Y., Zhao, M., Hu, Q., and Du, Y. (2023). Association of aquaporin-4 antibody-seropositive optic neuritis with vision-related quality of life and depression. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1265170"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Abe, R.Y., Medeiros, F.A., Davi, M.A., Gon\u00e7alves, C., Bittencourt, M.D., Roque, A.B., Boccato, J., Costa, V.P., and de Vasconcellos, J.P.C. (2019). Psychometric properties of the Portuguese version of the National Eye Institute Visual Function Questionnaire-25. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0226086"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1212\/WNL.0000000000001729","article-title":"International consensus diagnostic criteria for neuromyelitis optica spectrum disorders","volume":"85","author":"Wingerchuk","year":"2015","journal-title":"Neurology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S1474-4422(22)00187-9","article-title":"Optic neuritis and autoimmune optic neuropathies: Advances in diagnosis and treatment","volume":"22","author":"Bennett","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s00415-013-6957-4","article-title":"Chronic relapsing inflammatory optic neuropathy: A systematic review of 122 cases reported","volume":"261","author":"Petzold","year":"2014","journal-title":"J. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"123","DOI":"10.4103\/0301-4738.77024","article-title":"Management of ischemic optic neuropathies","volume":"59","author":"Hayreh","year":"2011","journal-title":"Indian J. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1167\/iovs.05-0981","article-title":"Visual acuities \u201chand motion\u201d and \u201ccounting fingers\u201d can be quantified with the Freiburg Visual Acuity Test","volume":"47","author":"Feltgen","year":"2006","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e963","DOI":"10.1111\/aos.14659","article-title":"A novel excel sheet conversion tool from Snellen fraction to LogMAR including \u201ccounting fingers\u201d, \u201chand movement\u201d, \u201clight perception\u201d and \u201cno light perception\u201d and focused review of literature of low visual acuity reference values","volume":"99","author":"Moussa","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.ajo.2006.06.060","article-title":"Validation and test characteristics of a 10-item neuro-ophthalmic supplement to the NEI-VFQ-25","volume":"142","author":"Raphael","year":"2006","journal-title":"Am. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1524-4733.2005.04054.x","article-title":"Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation","volume":"8","author":"Wild","year":"2005","journal-title":"Value Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/OPX.0b013e318141fe75","article-title":"The development, assessment, and selection of questionnaires","volume":"84","author":"Pesudovs","year":"2007","journal-title":"Optom. Vis. Sci."},{"key":"ref_30","unstructured":"R Core Team (2023). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v067.i01","article-title":"Fitting Linear Mixed-Effects Models Using lme4","volume":"67","author":"Bates","year":"2015","journal-title":"J. Stat. Softw."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Villoslada, P., Solana, E., Alba-Arbalat, S., Martinez-Heras, E., Vivo, F., Lopez-Soley, E., Calvi, A., Camos-Carreras, A., Dotti-Boada, M., and Bailac, R.A. (2024). Retinal Damage and Visual Network Reconfiguration Defines Visual Function Recovery in Optic Neuritis. Neurol. Neuroimmunol. Neuroinflamm., 11.","DOI":"10.1212\/NXI.0000000000200288"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/00041327-199703000-00004","article-title":"Visual symptoms after optic neuritis. Results from the Optic Neuritis Treatment Trial","volume":"17","author":"Cleary","year":"1997","journal-title":"J. Neuro-Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1177\/1352458519864928","article-title":"Aquaporin-4 IgG seropositivity is associated with worse visual outcomes after optic neuritis than MOG-IgG seropositivity and multiple sclerosis, independent of macular ganglion cell layer thinning","volume":"26","author":"Sotirchos","year":"2020","journal-title":"Mult. Scler. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s00415-024-12803-5","article-title":"Visual quality of life in NMOSD and MOGAD: Profiles, dynamics and associations with ageing and vision","volume":"272","author":"Nicolescu","year":"2024","journal-title":"J. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5173","DOI":"10.2147\/IJGM.S364051","article-title":"Vision-Related Quality of Life and Association Between Retinal Parameters in Patients with Non-Arteritic Anterior Ischemic Optic Neuropathy","volume":"15","author":"Su","year":"2022","journal-title":"Int. J. Gen. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Keren, S., Keren, S., Zanolli, M., and Dotan, G. (2017). Visual outcome following bilateral non-arteritic anterior ischemic optic neuropathy: A systematic review and meta-analysis. BMC Ophthalmol., 17.","DOI":"10.1186\/s12886-017-0543-y"},{"key":"ref_38","first-page":"1","article-title":"Factors Associated with Visual Acuity in Non-arteritic Ischemic Optic Neuropathy Patients: A Five-Year Cross-Sectional Study","volume":"14","author":"Kemchoknatee","year":"2022","journal-title":"Cureus"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Salvetat, M.L., Pellegrini, F., Spadea, L., Salati, C., and Zeppieri, M. (2023). Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview. Vision, 7.","DOI":"10.3390\/vision7040072"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/WNO.0000000000000421","article-title":"20\/40 or better visual acuity after optic neuritis: Not as good as we once thought?","volume":"36","author":"Sabadia","year":"2016","journal-title":"J. Neuro-Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1177\/135245850000600604","article-title":"Self-reported visual dysfunction in multiple sclerosis: Results from the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25)","volume":"6","author":"Balcer","year":"2000","journal-title":"Mult. Scler. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/WNO.0b013e318240204d","article-title":"Visual pathway axonal loss in benign multiple sclerosis: A longitudinal study","volume":"32","author":"Galetta","year":"2012","journal-title":"J. Neuro-Ophthalmol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/WNO.0000000000001870","article-title":"Predictors of Long-Term Visual Acuity in a Modern Cohort of Patients with Acute Idiopathic and Multiple Sclerosis-Associated Optic Neuritis","volume":"43","author":"Jarocki","year":"2023","journal-title":"J. Neuro-Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Dolcetti, E., Buttari, F., Bruno, A., Azzolini, F., Gilio, L., Di Caprio, V., Lauritano, G., Borrelli, A., Galifi, G., and Furlan, R. (2024). Low-contrast visual acuity test is associated with central inflammation and predicts disability development in newly diagnosed multiple sclerosis patients. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1326506"}],"container-title":["Neurology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2035-8377\/17\/11\/184\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T09:52:37Z","timestamp":1763113957000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2035-8377\/17\/11\/184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":44,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["neurolint17110184"],"URL":"https:\/\/doi.org\/10.3390\/neurolint17110184","relation":{},"ISSN":["2035-8377"],"issn-type":[{"type":"electronic","value":"2035-8377"}],"subject":[],"published":{"date-parts":[[2025,11,11]]}}}