Predictors of Lost to Follow-Up in Patients Being Treated for Proliferative Diabetic Retinopathy

Green, Michael; Tien, Thomas; Ness, Steven

doi:10.1016/j.ajo.2020.03.023

Cited by 28 publications

(47 citation statements)

References 26 publications

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“…The baseline LTF rate in our study (12%) is significantly lower than LTF rates observed in prior studies of DR patients, which range from 25% among post-procedure patients in Philadelphia to 61% among patients from nearby Boston Medical Center. 9,10 This broad range highlights the importance of evaluating the prevalence and predictors of LTF status on a local level. Across other ophthalmic subspecialties, loss to follow-up remains a pervasive issue as well.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, regular eye examinations are necessary to screen for the progression of DR and treat its complications, though adherence to this recommendation has been regrettably low. [8][9][10]…”

Section: Discussionmentioning

confidence: 99%

“…who have prolonged periods of loss to follow-up often experience a decline in vision, 8 and are more likely to suffer from complications of proliferative diabetic retinopathy (PDR). 9,10 Prior studies of patients with DR have reported local rates of loss to follow-up and have identified contributing factors, such as low income, advanced stages of retinopathy and/or other medical comorbidities. 9,11 Attempts to reduce the number of DR patients who fail to return for care have met with varying success.…”

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confidence: 99%

“…9,10 Prior studies of patients with DR have reported local rates of loss to follow-up and have identified contributing factors, such as low income, advanced stages of retinopathy and/or other medical comorbidities. 9,11 Attempts to reduce the number of DR patients who fail to return for care have met with varying success. Electronic medical record (EMR) systems are an important but underutilised tool available to improve the delivery of care to patients with DR and other eye conditions.…”

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confidence: 99%

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An initiative to improve follow‐up of patients with diabetic retinopathy

Sabharwal

Kuo

Roh

et al. 2022

Ophthalmic Physiologic Optic

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Background This study describes the implementation of an electronic medical record (EMR)‐based initiative aimed at identifying and reducing the number of patients with diabetic retinopathy (DR) lost to follow‐up (LTF). Method Providers were enlisted to review the EMRs and re‐engage patients with DR seen 1 year prior and who had not returned for care within the past 6 months. Binary logistic regression analysis was used to identify demographic, clinical and sociomedical factors associated with being LTF, as well as those predictive of re‐engagement. Results Out of 673 patients with DR, 78 (12%) were identified as LTF. Patients LTF were more likely to be younger (p = 0.001) and have poorly controlled haemoglobin A1c (HbA1c ≥ 8%, p = 0.04) and cholesterol (LDL ≥ 100 mg/dL, p < 0.001) levels. These patients were also more likely to have completed fewer ophthalmology appointments (p < 0.001), and less likely to have had retinal imaging within the last year (p < 0.001). Charts reviewed 1 month after the EMR‐based initiative revealed that 22 patients (28%) had been successfully re‐engaged by providers, while 56 patients (72%) remained LTF. History of prior treatment for DR was associated with re‐engagement by providers (p = 0.04). One month following the provider‐based intervention, the LTF rate dropped to 8.3%, and by 1 year only 3.6% of the patients remained LTF. Conclusions Electronic medical record‐based tools can successfully identify DR patients as being LTF, offering an opportunity for providers to re‐engage patients in a timely manner. Future studies are needed to determine the long‐term impact of patient re‐engagement on DR outcomes and efficiency of clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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An initiative to improve follow‐up of patients with diabetic retinopathy

Sabharwal

Kuo

Roh

et al. 2022

Ophthalmic Physiologic Optic

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“…24 A large volume of published research confirms that patients' sociodemographic factors affect the timeliness of ophthalmic care during nonpandemic periods. [25][26][27] During the COVID-19 period, multiple issues may have contributed to higher rates of deferral of care among low-income and minority patients, including reliance on public transportation systems or community health centers that were significantly disrupted during the pandemic. Research suggests that minority and low-income families are more likely to live in multigenerational households, 28 meaning these individuals may have had increased childcare or eldercare responsibilities during the lockdown period.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic and Demographic Factors Contributing to COVID-19–Related Delays and Reductions in Primary Retinal Detachment Repair in a US Hot Spot

Port

Gong

Shaikh

et al. 2021

Journal of VitreoRetinal Diseases

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Purpose: This work evaluates demographic and socioeconomic predictors of delayed care for rhegmatogenous retinal detachments (RRDs) during the spring 2020 COVID-19 shutdown in a US hot spot. Methods: This multicenter, retrospective, case-control study took place in 3 academic vitreoretinal practices in metropolitan Boston. Consecutive patients treated for RRD during the COVID-19 state of emergency were compared with patients treated during the same period in 2018 and 2019. The primary outcome was macula status for RRD. Secondary outcomes included visual acuity, symptom duration, proportion with proliferative vitreoretinopathy, time to procedure, method of repair, and patient demographics. Results: The total number of acute RRD decreased by 13.7% from 2018 to 2020 and 17.2% from 2019 to 2020. Symptom duration was significantly longer in 2020 than 2018 and 2019 (median, 7 vs 4 days) with a higher proportion of macula-off detachments (80 of 125 [64%] in 2020 vs 75 of 145 [51.7%] in 2018 and 78 of 151 [51.6%] in 2019). The 2020 cohort included significantly fewer patients in the racial and/or ethnic minority group than in 2019 ( P = .02), and use of low-income, government-sponsored health insurance was a predictor of macula-off status during the pandemic ( P = .04). Conclusions: RRDs during the spring 2020 COVID-19 lockdown were more likely to be macula-off at presentation. Because sociodemographic factors including race, ethnicity, and income level were associated with deferral of care, ophthalmologists should consider measures targeting vulnerable populations to avoid preventable vision loss as the pandemic continues or in future health care emergencies.

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Lapses in Care Among Patients Assigned to Ranibizumab for Proliferative Diabetic Retinopathy

et al. 2021

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IMPORTANCEThe follow-up schedule for individuals with eyes treated with anti-vascular endothelial growth factor agents for proliferative diabetic retinopathy (PDR) requires that patients return frequently for monitoring and repeated treatment. The likelihood that a patient will comply should be a consideration in choosing a treatment approach.OBJECTIVE To describe completion of scheduled examinations among participants assigned to intravitreous injections of ranibizumab for PDR in a multicenter randomized clinical trial. DESIGN, SETTING, AND PARTICIPANTSThis post hoc analysis evaluates data from a randomized clinical trial conducted at 55 US sites among 305 adults with proliferative diabetic retinopathy enrolled between February and December 2012. Both eyes were enrolled for 89 participants (1 eye to each study group), with a total of 394 study eyes. The final 2-year visit was completed in January 2015. Data were analyzed from April 2019 to July 2021.INTERVENTIONS Ranibizumab injections for PDR or macular edema. MAIN OUTCOMES AND MEASURESA long lapse in care of 8 or more weeks past a scheduled examination, dropout from follow-up, visual acuity at 5 years. RESULTS Among 170 participants, the median age was 51 years, and 44.7% were female. Through 5 years of follow-up, 94 of 170 participants (55.3%) had 1 or more long lapse in care. Median time to the first long lapse was 210 weeks, and 69 of 94 participants (73.4%) returned for examination after the first long lapse. Fifty of 170 participants (29.4%) dropped out of follow-up by 5 years. Among the 120 participants who completed the 5-year examination, median change from baseline in visual acuity was −2 letters for participants who had 1 or more long lapse compared with +5 letters for those without a long lapse (P = .02). After multivariable adjustment, the odds ratio (95% CI) for baseline associations with 1 or more long lapse was 1.21 (1.03-1.43) for each 5-letter decrement in visual acuity score, 2. 19 (1.09-4.38) for neovascularization of the disc and elsewhere, and 3. 48 (1.38-8.78) for no prior laser treatment for diabetic macular edema.CONCLUSIONS AND RELEVANCE Over 5 years, approximately half of the participants assigned to ranibizumab for PDR had a long lapse in care despite substantial effort by the DRCR Retina Network to facilitate timely completion of examinations. The likelihood of a long lapse in care during long-term follow-up needs to be considered when choosing treatment for PDR.

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Predictors of Lost to Follow-Up in Patients Being Treated for Proliferative Diabetic Retinopathy

Cited by 28 publications

References 26 publications

An initiative to improve follow‐up of patients with diabetic retinopathy

An initiative to improve follow‐up of patients with diabetic retinopathy

Socioeconomic and Demographic Factors Contributing to COVID-19–Related Delays and Reductions in Primary Retinal Detachment Repair in a US Hot Spot

Lapses in Care Among Patients Assigned to Ranibizumab for Proliferative Diabetic Retinopathy

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