Outcomes of Patients with Proliferative Diabetic Retinopathy Treated with Anti-VEGF Therapy and/or Panretinal Photocoagulation in the United States Who Were Lost to Follow-up.

PURPOSE: To examine visual outcomes and complications of eyes with proliferative diabetic retinopathy (PDR) that were lost to follow-up for >1 year after treatment with anti-VEGF therapy and/or panretinal photocoagulation in the United States.

DESIGN

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

SUBJECTS: A total of 2676 eyes of 2254 patients with PDR treated between 2013 and 2018 who were lost to follow-up for >1 year and then returned to care.

METHODS

Multivariable regression models were used to estimate odds ratios or relative risks and corresponding 95% confidence intervals.

MAIN OUTCOME MEASURES: Visual acuity (VA) and complications including diabetic macular edema, neovascular glaucoma, vitreous hemorrhage, and tractional retinal detachment.

RESULTS

Visual acuity significantly worsened at the return visit (logarithm of the minimum angle of resolution [LogMAR] VA, 0.485 [approximately 20/60]) compared with the visit before lost to follow-up (LogMAR VA, 0.436 [approximately 20/55]; P < 0.001) but returned to baseline acuity at a year after return visit (LogMAR VA, 0.437 [approximately 20/55]). The average time from return visit to visit before lost to follow-up was 679 days. On return, newly diagnosed complications included diabetic macular edema (14.4%), neovascular glaucoma (0.5%), vitreous hemorrhage (8.4%), and tractional retinal detachment (3.3%). Panretinal photocoagulation monotherapy was associated with a lower risk of complications and a lower risk of final VA worse than 20/200.

CONCLUSIONS

Patients who are lost to follow-up develop serious vision-threatening complications and are at risk for vision loss when they return for care. Future efforts should aim to maximize adherence with treatment for PDR to prevent vision loss.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.