medwireNews: North American researchers have identified key risk factors that may help predict which patients with proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME) are most likely to miss appointments or treatment in the year after visiting a retinal specialist.
“Identifying individuals at higher risk of LTFU [lost to follow-up] and developing targeted strategies may reduce disease progression and vision loss in individuals with PDR,” say Radha Kohly (Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada) and co-workers in JAMA Network Open.
The cohort study included 2961 patients with PDR or DME who received at least one antivascular endothelial growth factor intravitreal injection (anti-VEGF IVI) or panretinal photocoagulation (PRP) treatment in Toronto between 2012 and 2021 and were followed-up for an average of 61 months.
The patients were aged an average of 71 years, 55.4% were men, and 62.4% were White, while 22.5% were Asian, 6.9% were Black, and 6.1% were Hispanic. The majority (77.6%) were phakic and 22.4% were pseudophakic.
The primary endpoint of the study was the LTFU rate, defined as a patient not attending an ophthalmic visit or not receiving an intervention within 1 year of visiting their retinal specialist. This occurred in 17.1% of the patients, of whom 54.4% were temporarily LTFU and 45.6% were permanently LTFU.
In multivariable analysis, the patients most likely to be LTFU were men (odds ratio [OR]=1.23 vs women), those living more than 200 km from their point of care (OR=2.65 vs ≤20 km), and patients who were treated with PRP (OR=2.10 vs anti-VEGF IVI), after adjusting for a raft of factors including age, race, baseline best corrected visual acuity (BCVA), baseline DME, and treatment history.
By contrast, patients were significantly less likely to be LTFU if they were 85 years or older (OR=0.58 vs <65 years), had a baseline BCVA of more than 20/200 on the Snellen chart (OR=0.68 vs 20/40 or better), and if they had DME (OR=0.60 vs no DME). Six or more prior clinic visits also significantly reduced the likelihood of being LTFU (OR=0.78 vs <6 visits), as did having a high anti-VEGF IVI burden of six or more in the first year (OR=0.40 vs low burden).
“Patients with a greater severity of DR may require a more intensive treatment regimen, such as more frequent anti-VEGF IVIs, and such intensive therapy may incentivize patients to pursue regular follow-up,” postulate Kohly et al. “Less severe disease may be associated with patients becoming LTFU, as asymptomatic patients may feel a reduced urgency to attend follow-up appointments.”
The researchers also found that Black patients and Hispanic patients were significantly more likely to be LTFU than their White counterparts, with ORs of 2.10 and 1.54, respectively, prompting them to suggest that addressing the “multiple barriers to consistent health care access” experienced by racial and ethnic minorities “will require targeted interventions.”
Kohly and co-authors conclude: “It is imperative for clinicians to appreciate the complex interplay of factors associated with higher LTFU rates, which will inform strategies targeted at reducing the burden and frequency of patient nonadherence in this setting.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2025 Springer Healthcare Ltd, part of the Springer Nature Group
