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. 2025 Nov 1;48(11):1971-1977.
doi: 10.2337/dc25-1202.

Risk Factors and Consequences of Lapses in Proliferative Diabetic Retinopathy Care in a National Cohort

Serina S Applebaum  1 , Yanhong Deng  2 , Julia J Fu  1 , Michael Kane  3 , Kristen H Nwanyanwu  1 ; Sight Outcomes Research Collaborative (SOURCE) Consortium
Collaborators, Affiliations

Risk Factors and Consequences of Lapses in Proliferative Diabetic Retinopathy Care in a National Cohort

Serina S Applebaum et al. Diabetes Care. .

Abstract

Objective: To identify prevalence, risk factors, and visual outcomes associated with occurrence and duration of lapses in proliferative diabetic retinopathy (PDR) care.

Research design and methods: This was a retrospective national cohort study (2008-2023) of adults with PDR and ≥6 months of follow-up who were participating in the Sight Outcomes Research Collaborative. We used multivariable regressions to assess factors associated with lapse occurrence and duration, and compared post-lapse visual acuity by lapse duration.

Results: Among 15,211 individuals, 71.8% experienced a lapse in care; 14.2% of the lapses lasted >24 months. Lapses were more common among non-Hispanic Black, younger, and individuals with disability, and less common in those with poor vision or prior PDR treatment. Older age and PDR treatment predicted shorter lapses, and residence in distressed areas predicted longer lapses. Visual acuity worsened after lapses, with greater declines after longer lapses.

Conclusions: Prolonged lapses in PDR care are common, disproportionately affect vulnerable groups, and are associated with persistent vision loss.

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Conflict of interest statement

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
Multivariable logistic regression model of factors associated with having a lapse in care ≥6 months between ophthalmic visits for individuals with PDR. DCI, distressed communities index; Dx, diagnosis; HTN, hypertension; RUCA, rural urban commuting area; VA, visual acuity (in the better seeing eye).
Figure 2
Figure 2
Multivariable linear mixed effects model for factors associated with the duration of each lapse in ophthalmic care for individuals with PDR (clustered by patient). Dx, diagnosis; HTN, hypertension; VA, visual acuity (in the better seeing eye).
Figure 3
Figure 3
Visual acuity (VA) in the better-seeing eye (top) and in the eye with PDR or, for individuals with bilateral disease or unspecified laterality, in the worse-seeing eye (bottom) over time after a nonlapse (i.e., 1–6 months), short lapse (6–12 months), long lapse (12–24 months), or very long lapse (>24 months) in ophthalmic care for adults with PDR in a national cohort. We adjusted for age, sex, treatment modality, total follow-up duration, number of lapses, site, and baseline VA, accounting for the correlation of multiple observations on the same individual.
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References

    1. Teo ZL, Tham Y-C, Yu M, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis. Ophthalmology 2021;128:1580–1591 - PubMed
    1. Suresh R, Yu HJ, Thoveson A, et al. Loss to follow-up among patients with proliferative diabetic retinopathy in clinical practice. Am J Ophthalmol 2020;215:66–71 - PubMed
    1. Khurana RN, Wang JC, Zhang S, Li C, Lum F. Loss to follow up in patients with proliferative diabetic retinopathy treated with anti-VEGF therapy and/or panretinal photocoagulation in the United States. Ophthalmol Retina 2024;8:953–961 - PubMed
    1. Green M, Tien T, Ness S. Predictors of lost to follow-up in patients being treated for proliferative diabetic retinopathy. Am J Ophthalmol 2020;216:18–27 - PubMed
    1. Obeid A, Su D, Patel SN, et al. Outcomes of eyes lost to follow-up with proliferative diabetic retinopathy that received panretinal photocoagulation versus intravitreal anti-vascular endothelial growth factor. Ophthalmology 2019;126:407–413 - PubMed