Loss to Follow up in Patients with Proliferative Diabetic Retinopathy treated with Anti-VEGF Therapy and/or Panretinal Photocoagulation in the United States

Rahul N Khurana; Jay C Wang; Sen Zhang; Charles Li; Flora Lum

doi:10.1016/j.oret.2024.04.016

Loss to Follow up in Patients with Proliferative Diabetic Retinopathy treated with Anti-VEGF Therapy and/or Panretinal Photocoagulation in the United States

Ophthalmol Retina. 2024 Apr 22:S2468-6530(24)00191-X. doi: 10.1016/j.oret.2024.04.016. Online ahead of print.

Authors

Rahul N Khurana¹, Jay C Wang², Sen Zhang³, Charles Li³, Flora Lum³

Affiliations

¹ Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California. Electronic address: rnkhurana@gmail.com.
² Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
³ American Academy of Ophthalmology, San Francisco, California.

PMID: 38657954
DOI: 10.1016/j.oret.2024.04.016

Abstract

Purpose: To determine the rate of loss to follow up (LTFU) in patients with proliferative diabetic retinopathy (PDR) treated with anti-VEGF therapy and/or PRP in the United States.

Design: Retrospective cohort study using the national IRIS® Registry (Intelligent Research in Sight) data.

Subjects: 73,595 eyes of 56,590 patients with PDR diagnosed between 2013-2015 and treated between 2013-2018.

Methods: Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI).

Main outcome measures: LTFU was no follow up within 12 months from last treatment.

Results: For patient eyes treated for PDR, 11.7% (95% CI, 11.5-12.0) were LTFU. Among PDR patients treated with anti-VEGF therapy alone, PRP alone, and anti-VEGF and PRP, the rates of LTFU were 12.3% (95% CI: 11.8-12.7), 12.6% (95% CI, 12.1-13.0) and 10.8% (95% CI, 10.4-11.1) respectively. Risk factors for LTFU include Black or African American race/ethnicity (OR 1.26; 95% CI, 1.13-1.41; p<0.001), Hispanic ethnicity (OR 1.28; 95% CI, 1.16-1.42; p<0.001), Native American/Alaska Native or Native Hawaiian/Other Pacific Islander race/ethnicity (OR, 2.69; 95% CI, 2.14-3.38; p<0.001), and unilateral disease (OR 2.05; CI, 1.88-2.23; p<0.001). Odds for LTFU were higher with patients with baseline vision of 20/50-20/200 (OR, 1.25; 95% CI, 1.15-1.36; p<0.001) and with vision worse than 20/200 (OR, 1.22; 95% CI, 1.05-1.42; p=0.01) than for patient eyes with a baseline visual acuity of 20/40 or better. Odds for LTFU were lower for Medicare Fee For Service (OR, 0.71; 95% CI, 0.64-0.79; p<0.001) and Medicare Managed (OR, 0.66; 95% CI, 0.56-0.78; p<0.001) compared to Private insurance. Odds for LTFU were lower for patients treated in the Midwest (OR, 0.72; 95% CI, 0.64-0.81; p<0.001) and West (OR, 0.83; 95% CI, 0.74-0.94; p=0.003) compared to in the South region.

Conclusions: The rate of LTFU is between 10-12% among patients with PDR who were treated with anti-VEGF injections and/or PRP. Risk factors include Black or African American race/ethnicity, Hispanic ethnicity, baseline vision worse than 20/40, private insurance, South region and unilateral disease.

Keywords: Adherence; Loss to Follow Up; Proliferative diabetic retinopathy; United States; anti-VEGF therapy.