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Anti-VEGF intravitreal injection is the standard of care for patients with neovascular age-related macular degeneration or wet AMD. However, despite effective treatment options, many patients with wet AMD do not receive the recommended number of injections and follow-up visits annually. This retrospective cohort study, published in JAMA Ophthalmology, examined loss to follow-up rates to determine which patients are at risk. 

Results showed that of 9,007 patients, there was a 22.2% rate of loss to follow-up. Despite the prevalence of wet AMD in white populations, white patients were found to have the lowest loss to follow-up rates. In contrast, Black, Hispanic, Asian, and other minority patients were less likely to follow up with recommended anti-VEGF intravitreal injection appointments. 

Age was also found to be a risk factor for treatment nonadherence for patients who were 81 years old or older. Additionally, distance and socioeconomic status were correlated with loss to follow-up. Patients who lived a greater distance from their clinic and those who lived in neighborhoods of lower socioeconomic status were less likely to follow up. Lastly, unilateral eye disease was also associated with loss to follow-up. 

Language barriers were identified as one possible reason for the loss to follow-up of minority race patients, implying that interpreters and culturally competent healthcare workers could improve treatment adherence. Moreover, improving transportation infrastructure may also reduce loss to follow-up, especially for older patients and those living in faraway or less accessible neighborhoods. 

The researchers concluded that given the benefits of appropriate follow-up with anti-VEGF intravitreal injections for wet AMD, these risk factors should be considered when working with patients to identify who is at risk of being lost to follow-up. Doing so could help improve patient continuity of care and prevent unnecessary vision loss [1].

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Source:

[1] Obeid, A., Gao, X., Ali, F. S., Aderman, C. M., Shahlaee, A., Adam, M. K., Kasi, S. K., Hyman, L., Ho, A. C., & Hsu, J. (2018). Loss to follow-up among patients with neovascular age-related macular degeneration who received intravitreal anti–vascular endothelial growth factor injections. JAMA Ophthalmology, 136(11), 1251. https://doi.org/10.1001/jamaophthalmol.2018.3578

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