The Association of Lapses in Diabetic Retinopathy Care with Vision Impairment

To identify the association of lapses in diabetic retinopathy (DR) care with vision impairment among patients with type 2 diabetes (T2D), stratified by DR severity and treatment status.

Retrospective cohort study.

Adults with T2D seen at the Wilmer Eye Institute from 2013 to 2023.

Propensity score modeling was used to estimate the probability that a patient would experience a lapse in care during a 2-year observation window based on sociodemographic (age, sex, self-reported race or ethnicity, insurance), ocular (baseline visual acuity, ophthalmic comorbidities, history of retinal treatments), and medical factors (Diabetes Complication Severity Index, Charlson Comorbidity Index). Doubly robust logistic regression models using inverse probability weighting of the propensity scores were used to estimate the association of care lapses with vision impairment. We also estimated average marginal effects to examine the probability difference in vision impairment associated with care lapses among patients grouped by DR severity (no DR, nonproliferative DR, proliferative DR) and treatment status (no treatment, any treatment, anti-VEGF only, panretinal photocoagulation only).

Vision impairment (or vision worse than Snellen equivalent 20/40) at the end of the observation period.

A total of 45 764 patients with 90 440 eyes contributed to the study. Most patients were female (52%), and the average age was 61.7 years. A total of 81% had a lapse in care. Patients who had a lapse in care had 50% higher odds of having vision impairment compared with patients who never lapsed (P < 0.001). This association was seen across all subgroups of DR severity and treatment status (all P < 0.001).

For patients with T2D, a lapse in care was associated with higher odds of having vision impairment, regardless of underlying severity of DR or treatment status. These findings highlight the importance of longitudinal DR care and reducing lapses in care to prevent vision loss.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.