Abstract
Purpose :
The effect of missed appointments for anti-VEGF treatment for diabetic macular edema(DME) on visual acuity(VA) is unknown. We performed a secondary analysis of the DRCRNet Protocol T study to evaluate the association between visit adherence and VA in DME patients.
Methods :
Publicly available Protocol T data files were reviewed to characterize visit adherence. The 2-year Protocol T study required visits every 4 weeks(every 28-35 days) in the first year, then at variable intervals from 4-16 weeks in the second year. Visit adherence was measured as: total number of missed visits, average days between visits(avg days), average days of missed visits(avg missed days), longest interval between two visits(max days), maximum days of missed visits(max missed days), and visit constancy (percentage of 3-month periods with at least 1 visit attended). Avg and max missed days were categorized as being on time(0 days), late(1-59 days), and very late(>60 days). The primary outcome was change in ETDRS VA between the baseline study visit and the last visit. Multivariate linear regression models analyzed the association between visit adherence and change in VA, controlling for age, gender, race, ethnicity, diabetic status, baseline hemoglobin A1c, treatment arm, number of lasers/injections and baseline VA.
Results :
658 patients had complete visit data. Mean(standard deviation [SD]) number of missed visits was 1.7(3.5). 617(94%) patients had 100% visit constancy. Avg missed days were 43.1(77.6) days; when categorized, 333(51%) patients were classified as on time, 154(23%) late, and 171(26%) very late. The mean longest interval of missed visits was 52.0(93.2) days. After adjustment, significant associations included: each individual missed visit was associated with a decrease of -0.3 letters (95%CI: -0.6, -0.1, p=0.01); those in very late category of avg missed days saw 4.4(95%CI: -6.2, -1.8, p<0.001) letters less than those in the on time group; the very late group of max missed days was associated with worse final VA (-3.7 letters; 95%CI: -5.9, -1.7, p<0.001). Less than perfect visit constancy was also associated with reduced visual outcomes (-3.8 letters; 95%CI: -7.5, -0.1; p=0.04). See Table 1 for full results.
Conclusions :
Visit adherence contributes to visual acuity outcomes in DME.
This is a 2020 ARVO Annual Meeting abstract.