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Vikram S Makhijani, Jonathan Levine, Brandon B. Johnson, Pearl Rosenbaum; Adherence to therapy and treatment outcomes in patients with clinically significant macular edema treated with anti-VEGF therapy in an inner city hospital eye clinic: a quality improvement study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2097. doi: https://doi.org/.
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To measure compliance with follow-up recommendations in patients receiving anti-VEGF therapy for clinically significant macular edema (CSME) and to analyze quality of outcomes in compliant versus noncompliant patients.
A retrospective chart review of 80 consecutive patients with CSME seen at the hospital eye clinic between October 2014 and October 2015 and treated with a course of intravitreal Ranibizumab, Bevacizumab, or Aflibercept. Treatment choice was at the discretion of the treatment provider. Exclusion criteria were patients with prior injection, laser, or surgical treatment other than cataract extraction, or CSME secondary to non-diabetic etiology. Physician-prescribed follow-up interval (PFU) was compared to actual patient follow-up dates (AFU) and any discrepancy between the PFU and AFU or loss to follow-up was recorded. Patients with a discrepancy between PFU and AFU of greater than 21 days were considered non-adherent. Baseline and post-treatment best-corrected visual acuity (BCVA) were compared between the adherent and non-adherent groups using Student’s t-test. The following data were also recorded: central foveal thickness (CFT), age, ethnicity/race, insurance type, degree of retinopathy, number of treatments, type of treatments, and baseline and most recent hemoglobin A1c.
54% of patients were in the adherent group and 46% in the non-adherent group. Mean (SD) baseline BCVA was LogMAR 0.57 (0.17), and post-treatment 0.41 (0.18) after a mean of 3.6 (1.4) treatments. Mean delay from PFU for the total group was 23 days. Patients with a higher discrepancy between PFU and AFU (greater than 21 days increase) or lost to follow-up had a lower magnitude of acuity improvement (LogMAR 0.01 [0.24]) than those with higher compliance (LogMAR 0.33 [0.10]), p=0.01. Overall, 63% of patients had an improvement in acuity after treatments.
A large percentage of the studied population did not adhere to prescribed follow-up. This results in treatment outcomes for patients with CSME worse than in reported studies of compliant patient populations. Future research may explore and identify systems, health, or social issues which hinder adequate follow-up, and take measures to improve patient compliance in order to maximize visual rehabilitation.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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