Causes and Clinical Impact of Loss to Follow-Up in Patients with Proliferative Diabetic Retinopathy

Abstract

Purpose. This study determined the clinical impact and causes of loss to follow-up (LTFU) from the patients’ perspective in individuals with proliferative diabetic retinopathy (PDR) who received panretinal photocoagulation (PRP) and/or intravitreal injections (IVIs) of antivascular endothelial growth factor (VEGF). Methods. This prospective cohort study included 467 patients with PDR who received PRP and/or IVIs of anti-VEGF between May 2013 and June 2018. LTFU was defined as missing any follow-up visit for any interval exceeding 6 months, provided that patients eventually resumed care. Main outcome measures include rates and causes of LTFU. Results. A total of 391 patients (83.7%) were followed up, and 76 patients (16.3%) were LTFU over the study period. Rates of LTFU decreased with age (P=0.005). Questionnaire analysis conducted for patients’ LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient’s lack of trust and satisfaction with treatment (rs = 0.458, P<0.001). There was also a significant positive correlation between treatment unaffordability and number of IVIs of anti-VEGF (rs = 0.55, P<0.001) and lack of social support and age (rs = 0.39, P<0.001). Conclusions. LTFU threatens vision in PDR patients receiving PRP and/or IVIs of anti-VEGF. Possibly, patient-specific LTFU causes should be addressed before treatment in order to minimize the risk of LTFU. The clinical trial is registered with NCT04018326 (trial registration: ClinicalTrials.gov Identifier: NCT04018326, 10th of July 2019 “Retrospectively registered”).

Urgent and emergent glaucoma care during the COVID-19 pandemic: An analysis at a tertiary care hospital in South India

“…A substantial proportion of these postoperative patients were in critical or advanced stages of disease; possible progression during the lockdown may have greatly impacted visual status, as evidenced by prior studies. [ 35 ]…”

Non-compliance among diabetic macular oedema patients on antivascular endothelial growth factor therapy in Malaysia

“…Therefore, in order to reflect the local health care context, only Malaysian patients aged 18 years and older were included. Those who failed to attend review and/or treatment appointments for 6 months were identified as lost to follow-up (LTF) 15 . However, to determine the number of dropouts (i.e., those who should have been but were not under ongoing ophthalmic care), deceased patients, those whose care was transferred to another center or who were uncontactable, were excluded from further analysis.…”

A Paradigm Shift in the Management Approaches of Proliferative Diabetic Retinopathy: Role of Anti-VEGF Therapy

“…The various reasons causing LTFU, as studied based on the questionnaire, were trust and satisfaction concerns with the therapy, loss of corrected visual activity, affordability, age, devoid of social support, and frequency of anti-VEGF injections. 94 The study by Obeid et al also highlighted a few other causes for LTFU, such as type of procedure, race of the patient, distance from the clinic, associated complications as DME, and pain level perceived by the patient with the respective therapy. 95 Thus, LTFU could be minimised by addressing patient-centric problems at the initiation of the concerned therapy.…”