Loss to Follow-up Among Patients With Neovascular Age-Related Macular Degeneration Who Received Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Abstract

IMPORTANCE Loss to follow-up (LTFU) after anti-vascular endothelial growth factor (anti-VEGF) injections increases the risk of vision loss among patients with neovascular age-related macular degeneration (nAMD). OBJECTIVE To report rates of LTFU among patients with nAMD after anti-VEGF injections and to identify risk factors associated with LTFU in this population. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study of data from 9007 patients who received anti-VEGF injections for treatment of nAMD was performed at an urban, private retina practice with multiple locations from April 1, 2012, to January 12, 2016. MAIN OUTCOMES AND MEASURESRates of LTFU after anti-VEGF injections. Loss to follow-up was defined as receipt of 1 or more injections with no subsequent follow-up visit within 12 months. RESULTS Amongthe 9007 patients (mean [SD] age, 81.2 [8.8] years; 5917 [65.7%] female; 7905 [87.8%] white), 2003 (22.2%) were LTFU. Odds of LTFU were greater among patients 81 to 85 years of age (odds ratio [OR], 1.58; 95% CI, 1.38-1.82; P < .001), 86 to 90 years of age (OR, 2.29; 95% CI, 2.00-2.62; P < .001), and more than 90 years of age (OR, 3.31; 95% CI, 2.83-3.86; P < .001) compared with patients 80 years of age and younger. Odds of LTFU among African American patients (OR, 1.47; 95% CI, 1.00-2.16; P = .05), Asian patients (OR, 2.63; 95% CI, 1.71-4.03; P < .001), patients of other race (OR, 3.

Treatment compliance and adherence among patients with diabetic retinopathy and age-related macular degeneration treated by anti-vascular endothelial growth factor under universal health coverage

“…The LTFU rates were 5 to 10% over an observation period of 1 to 2 years in earlier randomized controlled trials for treatment of PDR [12,13]. Moreover, recent studies from the tristate region of Pennsylvania, New Jersey, and Delaware showed that 25% patients with PDR and 22% patients with nAMD were lost to follow-up for ≥ 12 months over a 4-year observation period [4,5]. When the regional average adjusted gross income was considered, the LTFU rate for patients with PDR and nAMD was as high as 34% and 26%, respectively.…”

“…Most patients with DR, who were lost to follow-up, had no subsequent follow-up after 6 (74.6%) or 12 months (83.5%). In the studies conducted by Obeid et al [4,14], the insurance status of patients was not documented, and the expense of treatment and follow-up examinations may have greatly influenced the adherence to treatment.…”

“…The complexity of noncompliance is reflected in a major review by Vermeire et al [16], which showed that demographic variables, disease factors, the duration or frequency of treatment, and the presence of psychiatric disorders were consistently unrelated to compliance in different medical specialties. In the field of ophthalmology, various reasons have been proposed for decreased compliance with rigorous follow-up schedules, including the lack of insurance coverage, age, grade of visual impairment, and increased distance between the residence and clinic [4,5,8,9].…”

“…In earlier studies, the lack of health insurance was hypothesized as a reason for underutilization of ophthalmological preventive care and treatment [6][7][8][9][10]. Therefore, the results of the studies by Obeid et al [4,5] may not be applicable to all healthcare systems. To the best of the authors' knowledge, there are no reports addressing LTFU rates during therapy for DR and nAMD in a universal healthcare system.…”

“…Compliance seems to be an important factor for successful therapy. Recent studies by Obeid et al [4,5] documented that 25.4% patients who received IVI or panretinal photocoagulation (PRP) for proliferative DR (PDR) and 22.2% patients who received IVI for nAMD were lost to follow-up ≥ 12 months. Moreover, the assessment of potential risk factors revealed the possible impact of the type of procedure, age, race, and the regional average adjusted gross income on treatment compliance of patients with PDR or nAMD.…”