Dual burden of ocular myasthenia gravis: A multicentre study of visual and psychosocial impact in a Malaysian cohort

Abstract

Background: Ocular myasthenia gravis (OMG) is a neuromuscular junction disorder characterised by fluctuating ptosis and variable ophthalmoplegia. While its motor manifestations are well recognised, the effects of OMG on vision-related quality of life (VRQoL) and psychological well-being remain underexplored.

Methods: This one-year multicentre cross-sectional study recruited 118 patients with OMG from four tertiary hospitals in Malaysia. VRQoL was assessed using the Visual Function Index-14 (VF-14), and psychological status using the Hospital Anxiety and Depression Scale (HADS). Associations with clinical and sociodemographic factors were examined using regression analyses.

Results: Patients had a mean age of 44.76 (SD 1.57) years and a mean disease duration of 4.31 (SD 0.28) years. The mean VF-14 score was 3.58 (SD 0.09), with visually demanding activities, such as reading small print and navigating steps, significantly more impaired than low-demand tasks. The mean HADS-D score was 4.92 (SD 4.12), with 51.7% of participants reporting mild to moderate depressive symptoms, whereas anxiety was uncommon (mean HADS-A 0.97, SD 1.34; 1.7% mild symptoms). Depressive symptoms were significantly associated with being single, ptosis affecting cosmesis, and work impairment due to OMG, while longer disease duration was protective. Anxiety was associated with younger age, Malay ethnicity, being single, systemic comorbidities, and work impairment.

Conclusions: Despite preserved visual acuity, fluctuating ptosis and diplopia significantly impair daily functioning and psychological well-being in OMG. The dissociation between relatively preserved visual function and emotional distress highlights the need for integrated care, including routine psychological screening, to improve overall quality of life.