Abstract
Purpose :
Patients with proliferative diabetic retinopathy (PDR) being treated with intravitreal injection (IVI) of anti-vascular endothelial growth factor (Anti-VEGF) medications or panretinal photocoagulation (PRP) typically require frequent follow up to optimize outcomes. We performed a retrospective cohort study to evaluate the rates of LTFU in patients with PDR undergoing treatment with IVI and/or PRP at an urban institution and identify risk factors associated with LTFU.
Methods :
Intervals between vitreoretinal specialist visits were assessed for a total of 418 adult patients with PDR who received IVI with anti-VEGF and/or PRP between January 1, 2014 and June 1, 2018. Patients were included if they had at least one documented follow up visit at least six months after the initial intervention. LTFU was defined as having had at least one interval exceeding six months duration between vitreoretinal appointments. Rates of LTFU were determined and risk factors associated with LTFU were identified using multivariate logistic regression.
Results :
Of a total of 418 patients included in the study, 256 patients (61%) were LTFU. Risk factors positively associated with LTFU on multivariate analysis included non-English primary language (OR = 1.83; 95% CI, 1.19 – 2.82; P = 0.006), age 56-65 years (OR = 1.86; 95% CI, 1.13 – 3.05; P = 0.014) and age older than 65 years (OR = 1.94; 95% CI, 1.08 – 3.48; P = 0.027) compared to age 55 years or younger, living 20 miles or less from the institution (OR = 2.68; 95% CI, 1.27 – 5.63; P = 0.009), having greater than 5 comorbidities (OR = 2.38; 95% CI, 1.07 – 5.29; P = 0.034), seeing 20 or more distinct departments (OR = 4.66; 95% CI, 1.52 – 14.28; P = 0.007), missing more than 10% of non-eye care appointments (OR = 1.61; 95% CI, 1.03 – 2.53; P = 0.038), and receiving only PRP compared to only IVI (OR = 1.93; 95% CI, 1.06 – 3.50; P = 0.031).
Conclusions :
A high percentage of patients being treated for active PDR at our institution were lost to follow up in an approximately 4-year time span. Several risk factors were associated with LTFU, including language, age, distance, comorbidities, number of departments seen at the institution, no-show rate in other departments, and PDR treatment modality. Identifying patients at high risk for LTFU may be an important consideration in choosing treatment modality and appropriate patient counseling.
This is a 2020 ARVO Annual Meeting abstract.