Predictors of loss to follow-up in neovascular age-related macular degeneration

To investigate the demographic, clinical, and treatment-related risk factors associated with being lost to follow-up (LTFU) among patients with neovascular age-related macular degeneration (nAMD) receiving antivascular endothelial growth factor (anti-VEGF) intravitreal injections (IVIs).

We conducted a multicentre retrospective cohort study of patients with nAMD treated with anti-VEGF IVIs in Toronto, Ontario, from January 2012 to December 2021. LTFU was defined as the absence of an ophthalmic visit within 1 year of the last retinal specialist appointment. Univariable and multivariable logistic regression analyses were conducted to examine associations between demographic, clinical, and treatment-related factors and becoming LTFU.

Among 2556 patients with nAMD, 527 (21%) were LTFU over a mean follow-up of 65.5 ± 15.2 months. In multivariable analysis, male sex (OR = 1.40; p < .001), greater travel distance (>200 km; OR = 2.51; p < .001), and multiple systemic comorbidities (≥3; OR = 1.39; p = .01) were associated with higher odds of LTFU. Compared with White patients, Black (OR = 2.07; p < .001) and Hispanic patients (OR = 1.70; p < .001) had increased odds of LTFU. In contrast, age ≥90 years (OR = 0.53; p < .001), worse baseline visual acuity (>20/200; OR = 0.72; p = .03), pseudophakia (OR = 0.80; p = .04), bilateral disease (OR = 0.72; p = .01), and higher first-year anti-VEGF injection burden (OR = 0.55; p < .001) were associated with lower odds of LTFU.

Male sex, Black or Hispanic race/ethnicity, multiple systemic comorbidities, and greater travel distance were associated with increased odds of becoming LTFU, while older age, worse baseline visual acuity, pseudophakia, bilateral disease, and higher IVI burden were protective factors. These findings can inform the development of targeted retention strategies for high-risk patients.