The Association Between Compliance with Recommended Follow-up and Glaucomatous Disease Severity in a County Hospital Population

Abstract

Purpose: : To assess the association between insufficient follow-up and clinical outcomes among glaucoma patients at San Francisco General Hospital.

Methods: : This case-control study enrolled 206 patients with established glaucoma. Cases (poor follow-up) and controls (good follow-up) were classified based upon compliance with follow-up exams at recommended intervals over the year preceding commencement of the study as determined by patient medical records. Glaucoma severity was assessed using the American Academy of Ophthalmology Preferred Practice Patterns guidelines. Multivariate logistic regression was used to analyze the data for an association between follow-up and disease severity.

Results: : Glaucoma disease severity was found to be significantly associated with adherence to recommended follow-up. In the unadjusted analysis, patients with mild/moderate glaucoma severity were more likely to have been adherent to their recommended follow-up than those patients with severe glaucomatous disease (crude OR 2.78, 1.54-5.00, P = 0.001). This finding was confirmed in the multivariate regression analysis which adjusted for the impact of potential confounding variables (adjusted OR 1.61, 95% CI 1.19-2.17, P = 0.002).

Conclusions: : Patients with poor follow-up adherence were significantly more likely to have severe glaucomatous disease suggesting that poor follow-up may contribute to disease worsening, perhaps by decreasing the opportunities for physician intervention when the disease is progressing; or, alternatively, those with more severe disease are less inclined or able to return for follow-up visits.

Keywords: clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology • clinical (human) or epidemiologic studies: risk factor assessment • clinical (human) or epidemiologic studies: outcomes/complications