Supplementary Material for: Digital Color Vision Testing Reveals Widespread Cone Dysfunction in Multiple Sclerosis Independent of Optic Neuritis

Introduction:
To investigate the prevalence and pattern of color vision deficiency (CVD) in relapsing-remitting multiple sclerosis (RRMS) patients, with or without a history of optic neuritis (ON), and to assess its potential as a marker of subclinical optic pathway dysfunction.
Methods:
Color vision was assessed in a large cohort of 345 RRMS patients using the Waggoner Computerized Color Vision Test (WCCVT), screening for protan, deutan, tritan, and composite color deficiencies, with severity grading based on score thresholds. Statistical differences between eyes with a history of ON, fellow eyes without ON, and eyes from MS patients with no history of ON were analyzed using multivariable logistic regression, controlled for age, gender, disease duration, Expanded Disability Status Scale, and treatment status.
Results:
Out of the 676 eyes analyzed, CVD was observed in 76.0% of ON-affected eyes, 65.1% of fellow eyes without ON, and 62.3% of eyes from patients without ON. Multivariable logistic regression showed ON-affected eyes had significantly higher odds of severe CVD compared to fellow eyes (OR=2.48, p=0.020), which in turn had higher odds of moderate CVD compared to the no-ON group (OR=2.27, p=0.010). Conversely, the no-ON group had higher odds of mild CVD compared to fellow eyes without ON (OR=2.01, p=0.003). Composite CVD was the most frequent type (57.7%), with tritan deficiencies being the most common pure type (39.9%). Fellow eyes demonstrated higher odds of composite CVD compared to the no-ON group (OR=1.97, p=0.016).
Conclusions:
CVD is highly prevalent in MS even without clinical ON, indicating diffuse, subclinical optic pathway damage.

引言：本研究旨在探讨伴或不伴视神经炎（Optic Neuritis, ON）病史的复发缓解型多发性硬化（Relapsing-Remitting Multiple Sclerosis, RRMS）患者的色觉障碍（Color Vision Deficiency, CVD）患病率与分型，并评估其作为亚临床视路功能障碍标志物的潜在价值。
方法：本研究纳入345名RRMS患者组成的大型队列，采用瓦格纳计算机化色觉测试（Waggoner Computerized Color Vision Test, WCCVT）评估色觉功能，筛查红敏型、绿敏型、蓝黄型及复合型色觉异常，并依据得分阈值进行严重程度分级。本研究采用多变量logistic回归分析，对有ON病史的患眼、对侧无ON病史眼以及无ON病史的MS患者的双眼进行统计学差异比较，校正因素包括年龄、性别、病程、扩展残疾状况量表（Expanded Disability Status Scale）评分及治疗状态。
结果：本研究共分析676只患眼，其中ON受累眼、对侧无ON病史眼以及无ON病史患者的患眼中，CVD检出率分别为76.0%、65.1%和62.3%。多变量logistic回归分析显示，与对侧无ON病史眼相比，ON受累眼出现重度CVD的优势比显著升高（OR=2.48，P=0.020）；而与无ON病史组相比，对侧无ON病史眼出现中度CVD的优势比更高（OR=2.27，P=0.010）。反之，与对侧无ON病史眼相比，无ON病史组出现轻度CVD的优势比更高（OR=2.01，P=0.003）。复合型色觉异常是最常见的分型（57.7%），蓝黄型色觉异常则是最常见的单纯型异常（39.9%）。与无ON病史组相比，对侧无ON病史眼出现复合型CVD的优势比更高（OR=1.97，P=0.016）。
结论：即使无临床ON病史，MS患者中CVD的患病率仍较高，提示存在弥漫性亚临床视路损伤。