A recent study in JAMA Network Open explored factors that put patients with proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME) at higher risk for loss to follow-up.
Give me some background first.
Diabetic retinopathy is a leading cause of blindness worldwide—and management of the disease requires regular and frequent follow-up.
However: Loss to follow-up (LTFU) is a significant obstacle to good outcomes for patients who have diabetic retinopathy, and may be influenced by multiple medical and personal factors.
Now, talk about the study.
This was a multicenter, retrospective review using electronic medical records (EMRs) of patients with PDR or DME treated in Toronto, Canada.
Its purpose: To assess the LTFU rate and associated factors.
- LTFU was defined as no ophthalmic visit or intervention for 1 year.
Associations between LTFU rates and the following patient characteristics were studied:
- Demographics such as age and sex
- Distance from primary residence
- Lens status
- Best-corrected visual acuity (BCVA)
- Presence of PDR or DME
- Treatment type
Who was included in the study?
Individuals were required to meet the following criteria to participate in the study:
- Age ≥ 18
- Diagnosis of PDR or DME, including if initially nonproliferative DR (NPDR), with development of PDR requiring treatment
- Received at least 1 PRP treatment or anti-VEGF intravitreal injection for PDR or DME during follow-up
- Follow-up with retina specialist for at least 1 year after initial consultation
Individuals were excluded if they did not require treatment for the entire duration of follow-up or were referred to another retina specialist.
Findings?
Of 2,961 patients with PDR or DME, 507 (17.1%) were LTFU over a follow-up period of 61 months. Those less likely to be LTFU were:
- Older patients, age ≥ 85 years vs age ≤65 years (P = 0.002)
- Patients with worse baseline visual acuity, >20/200 vs 20/40 or better (P = 0.04)
- Patients with DME (P = 0.003)
- Patients with frequent clinic visits (P = 0.04)
- Patients with high anti-vascular endothelial growth factor (VEGF) intravitreal injection (IVI) burden in the first year (P = 0.006)
Those more likely to be LTFU were:
- Males (P = 0.04)
- Patients who lived further from point of care (P < 0.001)
- Those treated with PRP (P < 0.001)
- Black (P < 0.001) and Hispanic (P = 0.03) patients, when compared with White patients
Limitations?
A few limitations may have restricted generalizability of these findings, including:
- Possibility for patients to seek care from other retina specialists
- Use of data points from a large, populous city
- Restriction of EMR data in reporting additional variables such as concomitant medications, health care accessibility, health literacy, and comorbidities
Take home.
Overall, the study authors concluded that patients who are male, Black or Hispanic, initially receiving PRP, living further from a care facility, as well as those with good baseline BCVA, lower IVI burden, and fewer follow-up appointments were more likely to be LTFU.
As such: Understanding these factors and how they play into follow-up care may help clinicians in developing ways to minimize LFTU.