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

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Purpose

To identify risk factors for patients with proliferative diabetic retinopathy (PDR) who are lost to follow-up (LTFU) while undergoing intravitreal injections of anti-VEGF (IVIs) and/or panretinal photocoagulation (PRP) at an urban institution.

Methods

A chart review was performed in a total of 418 adult patients with PDR who received IVI and/or PRP between January 1, 2014, and June 1, 2018, at the authors' institution. Rates of LTFU, risk factors associated with LTFU, and vision outcomes were assessed.

Results

Of a total of 418 patients, 256 patients (61%) were LTFU. Risk factors positively associated with LTFU on multivariate analysis included non-English as the primary language (odds ratio [OR], 1.83; P = .006); age 56-65 years old (OR, 1.86; P = .014); age older than 65 years (OR, 1.94; P = .027) compared to age 55 years or younger; living 20 miles or less from the institution (OR, 2.68; P = .009); having greater than 5 comorbidities (OR, 2.38; P = .034); seeing 20 or more distinct departments (OR, 4.66; P = .007); missing more than 10% of non-eye care appointments (OR, 1.61; P = .038); and receiving only PRP compared to only IVIs (OR, 1.93; P = .031).

Conclusions

A high percentage of patients treated for PDR at the authors' institution were LTFU over a 4-year time span. Identifying patients at high risk for being LTFU may help in choosing treatment modality and appropriate patient counseling.

Section snippets

Study Population

Approval from the Boston Medical Center Institutional Review Board was obtained prior to conducting this study, which was performed in accordance with the Health Insurance Portability and Accountability Act of 1996. Patients were identified for retrospective chart review using International Classifications of Diseases 9th and 10th revision codes for PDR and Current Procedural Terminology billing codes for IVI and PRP. Selection criteria for the study included males and females 18 years of age

Results

A total of 418 patients qualified for inclusion in the study, of which 256 patients (61%) were LTFU. Of patients who were LTFU, mean time of LTFU was 344 days (range, 181-1,078 days), with a median of 273 days. The mean (±SD) recommended follow-up time for visits prior to being LTFU was 3.3 (±2.1) months. Sixteen patients (3.83%) had a recommended follow-up time of greater than 6 months at least once during the study period. Descriptive characteristics of the authors' cohort are summarized in

Discussion

To date, this is the most comprehensive study examining risk factors for LTFU in patients being treated for PDR. Many of the variables assessed in this study have not been examined in this context previously in the medical literature. Specifically, variables unique to the present study include: primary language, history of mental illness and substance use; homelessness and food insecurity; insurance type; history of noncompliance and missed appointments in other clinics; history of NVI/NVG and

CRediT authorship contribution statement

Michael Green: Investigation, Formal analysis, Writing - original draft. Thomas Tien: Investigation, Writing - review & editing. Steven Ness: Conceptualization, Methodology, Writing - review & editing, Supervision.

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