Abstract
Purpose :
The American Academy of Ophthalmology recommends close regular follow up for patients with proliferative diabetic retinopathy (PDR) in order to prevent vision loss. Understudied elements of retention in care include the duration and number of lapses, i.e. periods of loss to follow up followed by return to care. We identified risk factors for longer and more frequent lapses in care among individuals with PDR and assessed the relationship between high risk lapses and systemic and visual outcomes.
Methods :
We performed a retrospective single-center chart abstraction of patients with PDR from 2012-2023. A lapse in care was defined as any interval ≥6 months between eye exams after diagnosis of PDR. We collected and used descriptive statistics to analyze demographic and socioeconomic factors, systemic comorbidities, and initial and final systemic and visual health. We used univariate and multivariable linear regression to assess these factors’ associations with duration of lapse and number of lapses per patient, as well as their associations with final outcomes.
Results :
Of 882 total patients with PDR, 698 (79%) had a lapse in care during the study period. The average lapse duration [SD] was 357.5 [269] days and average number of lapses per patient was 2.7 [2.1]. In adjusted models, Black or African American (AA) race was associated with 46.3 days longer (p=0.02), but 0.42 fewer (p=0.006), lapses than White race. Individuals with Medicare insurance and better initial visual acuity in ETDRS letter score (VA) were more likely to have lapses in care (β=0.46, p=0.047; β=0.01, p=0.012). Among all patients, systolic blood pressure (SBP), hemoglobin A1C (HbA1C), and intraocular pressure (IOP) all significantly improved from initial to final visit (all p<0.001), while VA did not change. Medicaid insurance was associated with a 9.41 point worse final VA (p=0.01) than private insurance; undergoing dialysis was associated with lower final HbA1C (β=-0.85, p<0.001); and Black or AA race was associated with 5.61mmHg higher SBP than White race (p=0.03).
Conclusions :
Black and AA patients are at risk for longer lapses in PDR eye care. More frequent or longer duration lapses in care were not associated with clinically significant different outcomes in our population. Further research may better elucidate the link between visit intervals and vision loss, which may impact follow-up recommendations.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.