Abstract
Purpose :
Lost to follow-up (LTF) is a perennial problem in glaucoma care. This study aimed to identify clinical and demographic factors predictive of LTF in patients with open-angle glaucoma (OAG) using an electronic medical record (EMR) reporting tool.
Methods :
We reviewed established patients with OAG seen prior to March 1, 2021 but had not returned for eye care in the following year. Demographic and clinical variables were extracted by the EMR reporting tool. Patients who transferred care, did not require further subspecialist care, or who were identified to be deceased were not considered LTF. Factors found to be associated with LTF by chi-square analysis or students t-test were analyzed via a multivariate regression.
Results :
Out of 2727 established patients with OAG, 351 (13%) had not returned for recommended care. Patients who were LTF were more likely to be older (average age 80.1 versus 77.6 years, p < 0.001), identify as Hispanic and/or Latin American (2.2% versus 0.93%, p = 0.034), speak a primary language other than English (9.6% versus 3.8%, p < 0.001), or have Medicare as their primary insurance (82% versus 76%, p = 0.025). Review of clinical characteristics found that patients who had worse visual acuity in the better seeing eye (LogMAR 0.26 versus LogMAR 0.16, p < 0.001), worse visual acuity in the worse seeing eye (LogMAR 0.66 versus LogMAR 0.45, p < 0.001), a larger average CDR (0.66 versus 0.63, p = 0.004), or lacked visual field testing (76% versus 85%, p < 0.001) were more likely to be LTF. Examining these factors by means of multiple regression revealed that older age (p = 0.005), lack of visual field testing (p = 0.007), or worse vision in the better seeing eye (p = 0.01) remained predictive of LTF after accounting for other variables.
Conclusions :
Using an EMR reporting tool allows for efficient identification and analysis of patients overdue for follow-up care. Our results indicate that elderly patients, those not up to date with ancillary testing, and patients with worse vision remain at highest risk for LTF. If consistent with other glaucoma clinic populations, additional clinic resources ought to be used to maintain vigilant follow-up care in these patients most vulnerable to vision loss due to OAG.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.