No-Show Propensity and Loss to Follow-Up Among Glaucoma Patients: A Retrospective Cohort Study

To identify risk factors for high first-year no-show propensity among glaucoma patients and assess its association with subsequent LTFU.

This retrospective cohort study included patients with a glaucoma diagnosis documented from 2013-2023 at a tertiary academic eye institute. Demographic, clinical, and appointment status data were extracted from the electronic health record. LTFU was defined as an interval of >365 days without an attended visit after the first-year observation window. No-show propensity factor (NSPF), a metric of appointment nonattendance that considers the total number of appointments and average no-show rate of the cohort, was calculated for each patient for their first year. Poisson regression models were used to identify risk factors for high NSPF (≥75th percentile). Cox proportional hazards models were used to evaluate the association between high NSPF and risk of subsequent LTFU.

The 7087 glaucoma patients had 37,249 scheduled appointments in their first year, 2778 (7.5%) of which were no-show. Risk factors for high NSPF included age < 60 years (relative risk [RR]=1.10, 95% confidence interval [CI]: 1.07-1.12), Black race (RR = 1.23, 95% CI: 1.21-1.25), Medicaid insurance (RR = 1.23, 95% CI: 1.19-1.28), and visual acuity 20/200 or worse in the better-seeing eye (RR = 1.09, 95% CI: 1.06-1.11). Three-quarters (72.0%) experienced at least one LTFU event. In an adjusted model, high NSPF predicted higher risk of subsequent LTFU (hazard ratio = 1.15, 95% CI: 1.08-1.22).

Demographic and clinical factors underlie risk of no-show propensity among glaucoma patients. Patients with a high propensity to no-show in their first year had greater risk of subsequent LTFU.