Abstract
Purpose :
Compliance with appointments among patients receiving treatment for diabetic retinopathy is a significant clinical challenge. Numerous factors may be associated with poor follow-up for these eyesight-saving treatments, including language. We hypothesize that Spanish-speaking (SS) patients with diabetic retinopathy are more likely to miss anti-vascular endothelial growth factor (VEGF) injection appointments and be lost to follow-up than English-speaking (ES) diabetic retinopathy patients.
Methods :
A retrospective chart review was collected for 664 patients with proliferative diabetic retinopathy (PDR) or non-proliferative diabetic retinopathy (NPDR) with diabetic macular edema (DME) who received intravitreal anti-VEGF treatments between January 1, 2012, and April 1, 2022. Missed follow-up after the first retina clinic visit and missed follow-up after the first anti-VEGF injection were defined as a greater than one-month delay in the recommended return-to-clinic time. Lost to follow-up (LTFU) was defined as no subsequent retina clinic visits within 12 months after ever receiving an intravitreal injection. Chi-square and log-rank tests were used to test for differences in compliance and LTFU rates between ES and SS patients.
Results :
Of the 664 patients, 561 (84.5%) were English speaking, 81 (12.2%) were Spanish speaking, and 22 (3.3%) reported other languages. Spanish speakers had a slightly higher rate of missed follow-up after the initial clinic visit at 15.0% compared to 13.1% for ES, but this difference was not statistically significant (p = 0.6). The follow-up rate after the first intravitreal injection was the same for ES and SS patients, with 13% of patients in both groups missing the follow-up visit (p = 0.9). The pattern of LTFU was different for ES and SS patients (p = 0.02). Of the 462 ES patients included in the LTFU analysis, 317 (68.6%) were LTFU with median time-to-LTFU of 16.7 months after the initial visit (95% CI: 14.1, 19.6). Of the 59 SS patients, 33 (55.9%) were LTFU with a median time-to-LTFU of 37.8 months after the initial visit (95% CI: 23.1, 67.3).
Conclusions :
Our results suggest that, regardless of language, patients with diabetic retinopathy have a high rate of poor appointment compliance and are frequently lost to follow-up. Further examination and analysis are needed to determine what factors may be most helpful in predicting treatment compliance.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.