A recent retrospective study published in Ophthalmic Epidemiology followed glaucoma patients to assess the effects of loss-to-follow-up (LTFU)—incidence, risk factors, and clinical consequences—over a 10-year period.
Talk about this research.
Researchers at Duke University School of Medicine evaluated a cohort of 395 glaucoma patients (57% White, 39% Black) who had a clinical encounter from 2010 and followed through 2019.
They conducted a chart review of patients’ glaucoma clinic visit intervals, including documenting their moves, discharges, and (if applicable) deaths.
To note, all patients’ charts were randomly selected and abstracted into a secure database.
How did they track disease progression?
For patients who returned for a glaucoma clinic visit after 52+ weeks, researchers reviewed clinic notes for any indications of disease progression, treatment escalation, or glaucoma-related complications.
Disease progression was based on an ophthalmologist’s interpretation of the patient’s visual field data, optical coherence tomography (OCT) analysis, and optic nerve head examination.
And how was LTFU defined?
Per the investigators, LTFU was defined as <52 weeks without a glaucoma-related encounter.
Patients with return visits after 52 weeks were not considered LTFU.
Findings?
Per the study, over the course of the 10-year period, 33% (132) of patients were LTFU.
The average amount of time between these patients’ last visit before LTFU and their return visit was 1,245 days (range = 485 to 3,626 days).
Of the 132 patients, only 17% (23) later return care—with two-thirds of whom returned with disease progression or complication.
Where were the risk factors for LTFU?
Statistically significant risk factors (in a logistic regression model) included:
Greater disease severity (odds ratio [OR] = 1.03 [1.01–1.05], p = 0.023, for each worsening decibel of mean deviation) as well as in-state rather than out-of-state residence (OR = 2.76 [1.12–6.80], p = 0.027)—a contrast, investigators noted, to prior research.
Risk factors that did not reach significance included:
- Male gender (OR = 1.39 [0.92–2.13], p = 0.124)
- Black race (OR = 1.40 [0.91–2.16] p = 0.123)
- Legal blindness (OR = 1.58 [0.91–2.76] p = 0.107)
Limitations?
Investigators noted that a deeper evaluation of in-state vs out-of-state residency was not conducted, as well as the impossibility of comparing clinical outcomes of LFTU patients to those that returned.
Take home.
The study authors concluded that, based on the findings, “LTFU may be associated with poor clinical outcomes.”However, they noted the need for further research to understand why LTFU occurs as well as to promote regular glaucoma care.