Abstract
Purpose :
Randomized clinical trials of treatment of proliferative diabetic retinopathy (PDR) have shown that a regimen of intravitreous anti-vascular endothelial growth factor (VEGF) injections provides noninferior, or in some analyses, superior, visual acuity and other outcomes compared with panretinal photocoagulation (PRP). Nevertheless, PRP may be perceived as advantageous from the perspective of relying less on adherence to close follow-up than anti-VEGF-based protocols. Limited data from clinical practice are available on rates of follow-up for patients with treatment-naïve PDR offered PRP or anti-VEGF. We reviewed one-year follow-up patterns of patients with PDR offered treatment with PRP or anti-VEGF in a tertiary academic center, reporting preliminary results here for patients offered PRP.
Methods :
Following approval by the Johns Hopkins Medicine Institutional Review Board, we retrospectively reviewed 91 patients of retinal specialists at our institution (2006-2016) who had PDR without prior PRP in at least one eye. Kaplan-Meier survival curve analysis modeled time-to-loss-to-follow-up, defined as 4 or more months without follow-up by a retinal specialist. A Cox proportional hazards model tested effects of baseline characteristics on time-to-loss-to-follow-up.
Results :
Baseline characteristics are in Table 1. Median time-to-loss-to-follow-up was 7.5 months (95% CI, 5.5-9.8). The mean number of visits per patient was 7.9 ± 3.8. 25.3% of patients were never lost to follow-up over one year. No baseline characteristic was associated with time-to-loss-to-follow-up at the P<0.10 level. Only 53.8% of patients had complete PRP in the first eye to be treated within one year of follow-up (mean PRP sessions = 2.0 ± 1.2).
Conclusions :
Three-quarters of patients offered PRP for PDR were lost to follow-up for 4 or more months within one year of presentation. Approximately half of patients had complete PRP in the first eye to be treated within one year. Baseline demographic and ocular characteristics were not significantly associated with likelihood of loss to follow-up within one year. Data collection is ongoing with a larger cohort and to identify patients with at least one year of follow-up after treatment with anti-VEGF.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.