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Multicenter Study
. 2024 Nov-Dec;7(6):572-579.
doi: 10.1016/j.ogla.2024.07.007. Epub 2024 Jul 20.

Factors Associated with Nonreturn after Loss to Follow-Up from Glaucoma Care: An IRIS® Registry Retrospective Analysis

Lauren M Wasser  1 , Julie Cassidy  2 , Hsing-Hua Sylvia Lin  3 , Andrew M Williams  4
Affiliations
Multicenter Study

Factors Associated with Nonreturn after Loss to Follow-Up from Glaucoma Care: An IRIS® Registry Retrospective Analysis

Lauren M Wasser et al. Ophthalmol Glaucoma. 2024 Nov-Dec.

Abstract

Purpose: Loss to follow-up (LTFU) in primary open-angle glaucoma (POAG) can lead to undertreatment, disease progression, and irreversible vision loss. Patients who become LTFU either eventually re-establish glaucoma care after a lapse or never return to the clinic. The purpose of this study is to examine a large population of patients with POAG who became LTFU to determine the proportion that return to care and to identify demographic and clinical factors associated with nonreturn after LTFU.

Design: Retrospective longitudinal cohort study.

Participants: Patients with a diagnosis of POAG with a clinical encounter in 2014 in the IRIS® Registry (Intelligent Research in Sight).

Methods: We examined follow-up patterns for 553 663 patients with POAG who had an encounter in the IRIS Registry in 2014 by following their documented clinic visits through 2019. LTFU was defined as exceeding 1 calendar year without an encounter. Within the LTFU group, patients were classified as returning after a lapse in care (return after LTFU) or not (nonreturn after LTFU).

Main outcome measures: Proportion of patients with nonreturn after LTFU and baseline demographic and clinical characteristics associated with nonreturn among LTFU patients with POAG.

Results: Among 553 663 patients with POAG, 277 019 (50%) had at least 1 episode of LTFU over the 6-year study period. Within the LTFU group, 33% (92 471) returned to care and 67% (184 548) did not return to care. Compared to those who returned to care, LTFU patients with nonreturn were more likely to be older (age >80 years; relative risk [RR] = 1.48; 95% confidence interval [CI]: 1.47-1.50), to have unknown/missing insurance (RR = 1.31; 95% CI: 1.30-1.33), and to have severe-stage POAG (RR = 1.13; 95% CI: 1.11-1.15). Greater POAG severity and visual impairment were associated with nonreturn with a dose-dependent relationship in the adjusted model that accounted for demographic characteristics. Among those with return after LTFU, almost all returned within 2 years of last appointment (82 201; 89%) rather than 2 or more years later.

Conclusions: Half of patients with POAG in the IRIS Registry had at least 1 period of LTFU, and two thirds of LTFU patients with POAG did not return to care. More effort is warranted to re-engage the vulnerable patients with POAG who become LTFU.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Adherence; Appointment attendance; Loss to follow-up; Nonreturn; Primary open-angle glaucoma.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: No conflicting relationship exists for any author.

Figures

Figure 1.
Figure 1.
Attrition diagram of study patients POAG, primary open angle glaucoma; VA, visual acuity; IOP, intraocular pressure; CDR, cup-to-disc ratio; LTFU, loss to follow up (defined as lapsing at least one full calendar year without a documented encounter).
Figure 2.
Figure 2.
Duration of loss to follow up among 92,471 patients with primary open-angle glaucoma who returned to care after a lapse of at least one year
See this image and copyright information in PMC

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