A quarter of patients with diabetic macular edema who received an anti-VEGF injection to treat nonproliferative diabetic retinopathy did not return for a follow-up visit within the ensuing 12 months, according to a study.
The retrospective cohort study analyzed billing data for 1,632 patients who underwent treatment at Wills Eye Hospital or Mid Atlantic Retina from Jan. 1, 2012, to Jan. 1, 2017. A total of 413 subjects (25.3%) were deemed lost to follow-up (LTFU), meaning they did not appear for an office visit within a year of receiving an injection.
The study not only looked at the rate of LTFU but also potential risk factors contributing to noncompliance, including age, gender, race/ethnicity, average adjusted gross income, eye involvement, diabetic retinopathy stage, insurance coverage and distance from the patient’s home to the clinic. Most predictive of LTFU were lower income, certain race/ethnicities and worse baseline visual acuity.
There was a statistically significant difference in the number of patients LTFU with average adjusted gross income of less than $50,000 per year compared with incomes of $50,000 to $75,000 or income greater than $75,000 per year (P < .001). Regarding race/ethnicity, Hispanic patients and patients reported as “other” and “unknown” were more likely than whites to be LTFU. In a subgroup analysis, the highest rate of LTFU was seen in patients with baseline visual acuity of 20/80 or worse, at a rate of 3.57 times the rate of LTFU in patients with baseline visual acuity of 20/50 or better (P < .001).
One explanation for the poor follow-up “may be due to a cultural and communication barrier because there are no Hispanic physicians in our practice. ... Given the increased prevalence of diabetes coupled with higher rates of noncompliance with eye care, greater attention should be paid to this population to lower the risk of vision impairment,” the study authors wrote. – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures for this study.