Patients Treated for Proliferative Diabetic Retinopathy Are Frequently Lost to Follow-Up

Rahul N. Khuruna, MD

About 1 in every 10 patients with proliferative diabetic retinopathy (PDR) are lost to follow-up after receiving anti-VEGF and/or panretinal photocoagulation (PRP) therapy for their condition, according to a new cohort analysis.

The new data, presented at the American Society of Retina Specialists (ASRS) 2021 Scientific Meeting this weekend, showed that Hispanic and African-American patients were even more likely to be lost to PDR treatment follow-up, with findings that emphasized the need for bolstered therapy adherence among populations at risk of losing vision from their chronic disease.

“When patients are lost to follow up, the ideal care is not delivered and patients likely suffer irreversible vision loss,” investigators wrote.

Led by Rahul N. Khurana, MD, Partner of Northern California Retina Vitreous Associates and Clinical Associate Professor of Ophthalmology at UCSF Medical Center, investigators sought to observe the incidence and relevant demographics of patients with PDR being treated with standard therapy. Khurana and colleagues used the US-based IRIS Registry database to observe such correlations in patients diagnosed from 2013 to 2015.

The cohort analysis included 102,867 eyes of patients with PDR from the IRIS registry who were treated with anti-VEGF therapy and/or PRP between 2013 and 2018. Investigators defined loss to follow-up as >12 months since last administered treatment. They determined odds ratios (ORs) and 95% confidence intervals (CIs) via multivariable logistic regression analysis of patient baseline demographic and clinical conditions.

Khurana and colleagues observed that 10.7% (95% CI, 10.3 – 11.0) of patients with PDR treated with lone anti-VEGF were lost to follow-up, versus 9.5% (95% CI, 9.2 – 9.8) of patients treated with PRP alone. Another 9.8% (95% CI, 9.4 – 10.1) of patients on both therapies were lost to follow-up.

Among patients on lone anti-VEGF, African-American patients (OR, 1.2; 95% CI, 1.1 – 1.3; P = .005) and Hispanic patients (OR, 1.2; 95% CI, 1.0 – 1.3; P = .008) were approximately 20% more likely to be lost to follow-up than white patients. The odds were even greater among the same patient demographics being treated with lone PRP (ORs, 1.4; 1.3, respectively).

Investigators observed a decreased risk of loss to follow-up among patients with Medicare insurance versus private insurance.

The team concluded that risk factors for loss to treatment follow-up among patients with PDR include increasing age, male sex, African-American and Hispanic ethnicity, unilateral involvement, and private insurance.

“There is a high rate of loss to follow-up after anti-VEGF injections and PRP among patients with PDR,” investigators wrote. “Improving treatment adherence and follow up is critical to prevent vision loss in PDR.”

The study, “Loss to Follow-up in Patients With Proliferative Diabetic Retinopathy Treated With Anti-VEGF Therapy and/or PRP in the United States,” was presented at ASRS 2021.