Persistent Vision Loss of Eyes Lost to Follow-Up with Diabetic Macular Edema Receiving Intravitreal Anti-VEGF Therapy

To describe the visual and anatomic outcomes after being lost to follow-up (LTFU) among patients with diabetic macular edema (DME) that treated by intravitreal anti-VEGF therapies, and to determine the risk factors of persistent vision loss.

A retrospective cohort study using national registry data.

A total of 5660 patients who were LTFU >6 months after anti-VEGF treatments from April 2020 through July 2024.

Visual and anatomic outcomes at the visit before being LTFU, the return visit, 3 months, 6 months, and 12 months after return, and the final visit were collected. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for persistent vision loss.

Visual acuity (VA) and central foveal thickness (CFT).

After a mean LTFU period of 11.3 months, 2712 (47.9%) patients had vision decline at return visit. Identified risk factors included increasing age (45-64 years vs. ≤44 years: OR, 1.30; 95% CI, 1.07-1.56; P = 0.007; ≥65 years vs. ≤44 years: OR, 1.41; 95% CI, 1.15-1.72; P = 0.001), being treated in less developed regions (OR, 1.20; 95% CI, 1.08-1.34; P = 0.001), better baseline VA (20/50-20/200 vs. worse than 20/200: OR, 3.20; 95% CI, 2.67-3.83; P < 0.001; 20/40 or better vs. worse than 20/200: OR, 5.89; 95% CI, 4.86-7.12; P < 0.001), and being LTFU for >12 months (OR, 1.22; 95% CI, 1.09-1.37; P = 0.001). A total of 792 patients returned with worsened vision and underwent ≥12 months of follow-up after resuming therapies. After a mean follow-up time of 17.3 months, 522 (65.9%) patients had persistent vision loss. Central foveal thickness presented paralleled changes with VA. Odds of persistent vision loss were greater among patients with VA of 20/40 or better before being LTFU (OR, 2.54; 95% CI, 1.25-5.15; P = 0.010) or having CFT of 350μm or more at return (OR, 1.57; 95% CI, 1.15-2.16; P = 0.005). In retreatment, odds of persistent vision loss were lower for patients who switched anti-VEGF agents (OR, 0.61; 95% CI, 0.45-0.84; P = 0.002) after return.

Nearly half of the patients had vision decline after being LTFU, and after resuming therapies, vision loss still persisted in 2 of 3 patients. Clinical adherence should be strengthened for patients with baseline VA of 20/40 or better or having CFT of 350 μm or more at return. Multiple agents used were associated with vision recovery.

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