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Factors Associated with Nonreturn after Loss to Follow-Up from Glaucoma Care: An IRIS® Registry Retrospective
Lauren M Wasser1, Julie Cassidy2, Hsing-Hua Sylvia Lin3
1Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Ophthalmology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel.
Purpose:
Loss to follow-up (LTFU) in primary open-angle glaucoma (POAG) can lead to undertreatment, disease progression, and irreversible vision loss. Patients who become LTFU either eventually re-establish glaucoma care after a lapse or never return to the clinic. The purpose of this study is to examine a large population of patients with POAG who became LTFU to determine the proportion that return to care and to identify demographic and clinical factors associated with nonreturn after LTFU.
Design:
Retrospective longitudinal cohort study.
Participants:
Patients with a diagnosis of POAG with a clinical encounter in 2014 in the IRIS® Registry (Intelligent Research in Sight).
Methods:
We examined follow-up patterns for 553 663 patients with POAG who had an encounter in the IRIS Registry in 2014 by following their documented clinic visits through 2019. LTFU was defined as exceeding 1 calendar year without an encounter. Within the LTFU group, patients were classified as returning after a lapse in care (return after LTFU) or not (nonreturn after LTFU).
Main Outcome Measures:
Proportion of patients with nonreturn after LTFU and baseline demographic and clinical characteristics associated with nonreturn among LTFU patients with POAG.
Results:
Among 553 663 patients with POAG, 277 019 (50%) had at least 1 episode of LTFU over the 6-year study period. Within the LTFU group, 33% (92 471) returned to care and 67% (184 548) did not return to care. Compared to those who returned to care, LTFU patients with nonreturn were more likely to be older (age >80 years; relative risk [RR] = 1.48; 95% confidence interval [CI]: 1.47-1.50), to have unknown/missing insurance (RR = 1.31; 95% CI: 1.30-1.33), and to have severe-stage POAG (RR = 1.13; 95% CI: 1.11-1.15). Greater POAG severity and visual impairment were associated with nonreturn with a dose-dependent relationship in the adjusted model that accounted for demographic characteristics. Among those with return after LTFU, almost all returned within 2 years of last appointment (82 201; 89%) rather than 2 or more years later.
Conclusions:
Half of patients with POAG in the IRIS Registry had at least 1 period of LTFU, and two thirds of LTFU patients with POAG did not return to care. More effort is warranted to re-engage the vulnerable patients with POAG who become LTFU.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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