Delayed Follow-Up in Patients With Neovascular Age-Related Macular Degeneration Treated Under Universal Health Coverage

Abstract

Background/Purpose: To report the rate of delayed follow-up visits (DFU), to identify risk factors of DFU, and to assess the impact of DFU on outcomes in neovascular agerelated macular degeneration.Methods: This retrospective study included all patients with neovascular age-related macular degeneration (n = 1,291) treated with antivascular endothelial growth factor injections between January 2013 and December 2020 in 2 centers in Quebec, Canada. A DFU was defined as a delay of $4 weeks than scheduled. Visual outcomes, especially $15 letters loss, were reported.Results: A total of 351 patients (27.2%) experienced $1 DFU. Odds were greater among older patients (P = 0.005), patients treated at the hospital rather than the clinic (P , 0.001), and patients with worse initial visual acuity (P = 0.024). A DFU was associated with a mean visual acuity loss of 4.2 ± 13.4 letters (P , 0.001) and an increased incidence of intraretinal fluid and subretinal fluid (P = 0.001, P = 0.005) at 6 months despite resumption of injections. Central foveal thickness increased after DFU but returned to pre-DFU visit at 6 months. Conclusion:The DFU rate in patients with neovascular age-related macular degeneration treated under a universal health care system was around 27%. Delayed follow-up visits caused significant decreases in visual acuity and increases in intraretinal fluid and subretinal fluid on optical coherence tomography that did not recover after injections resumption despite normalization of central foveal thickness.

Non-adherence and non-persistence to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy: a systematic review and meta-analysis

“…Thirty-five studies assessed patients who had been treated with intravitreal Ranibizumab injections [ 8 , 9 , 13 , 15 , 25 – 31 , 33 – 39 , 41 , 43 , 47 – 51 , 53 , 55 – 58 , 60 – 62 , 70 , 71 ]. Twenty-one studies assessed patients taking Aflibercept injections [ 15 , 26 , 34 – 36 , 38 , 39 , 41 , 43 , 45 , 49 – 52 , 63 – 66 , 68 , 70 , 71 ].…”

“…Twenty-one studies assessed patients taking Aflibercept injections [ 15 , 26 , 34 – 36 , 38 , 39 , 41 , 43 , 45 , 49 – 52 , 63 – 66 , 68 , 70 , 71 ]. Seventeen studies included Bevacizumab as the intravitreal drug [ 29 , 32 , 35 , 38 , 39 , 41 , 45 , 46 , 49 – 51 , 57 , 61 , 62 , 69 – 71 ], and three studies looked at patients treated with Pegaptanib sodium, all anti-VEGF agents [ 45 , 48 , 57 ]. Eight studies did not specify the drug used for intravitreal treatment [ 24 , 40 , 42 , 44 , 54 , 59 , 67 , 69 ].…”

“…Twenty studies had a duration of over 3 years [ 9 , 15 , 24 , 28 – 30 , 35 , 39 , 40 , 46 , 47 , 49 – 52 , 61 , 63 , 65 , 66 , 70 ]. The studies with the longest duration over which data was collected investigated discontinuation over an 8-year period [ 51 ]. The oldest studies collected patient data from 2006, and the latest data sets were during 2022.…”

Diagnostic accuracy of community optometrists for age‐related macular degeneration using colour fundus photographs: A pilot evaluation

“…An accurate diagnosis is critical for increasing the likelihood of retaining good functional vision in AMD patients 12 . Indeed, accurate diagnosis by clinicians leading to timely treatment of neovascular AMD has consistently demonstrated better visual acuity outcomes 13,14 . However, an extensive PubMed literature search did not reveal any formal studies reporting the diagnostic accuracy of community clinicians for AMD.…”