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

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 panretinal photocoagulation (PRP) in the United States.

Design

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

Subjects

A total of 73 595 eyes of 56 590 patients with PDR diagnosed between 2013 and 2015 and treated between 2013 and 2018.

Methods

Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Main Outcome Measures

Loss to follow up 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 patients with PDR 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 (odds ratio [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 to 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 with 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 with in the South region.

Conclusions

The rate of LTFU is between 10% and 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.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.