Factors Contributing to Follow-up Nonadherence After Infectious Keratitis Diagnosis

To evaluate demographic, socioeconomic, and clinical factors associated with nonadherence with initial follow-up after a diagnosis of infectious keratitis.

A retrospective chart review of patients aged 18 to 60 years who were diagnosed with infectious keratitis at the Wills Eye Hospital Emergency Room from March 2019 to September 2019 was conducted. The primary outcome was nonadherence with initial follow-up recommendation and included patients who did not follow-up in the time frame requested by the diagnosing physician and those who were lost to follow-up.

Two hundred and seventeen patients were included with a mean age of 39.0±11.6 years, and 38.2% of patients were nonadherent. Patients who identified as non-Hispanic White were more likely to be nonadherent compared with Hispanic White patients (odds ratio [OR]=5.00, 95% confidence interval [CI]: 1.27-20.00, P =0.021). Additional variables associated with nonadherence included lower income (OR=0.92, 95% CI: 0.85-0.99, P =0.020) and government versus private insurance (OR=2.13, 95% CI: 1.09-4.15, P =0.027). Among clinical variables, patients not cultured at the initial evaluation were more likely to be nonadherent (OR=2.54, 95% CI: 1.36-4.77, P =0.004).

Race, income, insurance, and corneal culturing had associations with follow-up nonadherence. Identifying barriers to follow-up for infectious keratitis may have important implications in preventing vision loss and other complications.