Outcomes of Patients with Proliferative Diabetic Retinopathy Treated with Anti-VEGF Therapy and/or Panretinal Photocoagulation in the United States Who Were Lost to Follow-up

Summary

PDR treated with anti-VEGF and/or PRP and lost to FU develop serious VA complications, and are at risk for VA loss when returning for care. IRIS Registry.

Abstract

Purpose: To examine visual outcomes and complications of eyes with proliferative diabetic retinopathy (PDR) that were lost to follow-up for >1 year after treatment with anti-VEGF therapy and/or panretinal photocoagulation in the United States.

Design: Retrospective cohort study from the national IRIS® Registry (Intelligent Research in Sight).

Subjects: A total of 2676 eyes of 2254 patients with PDR treated between 2013 and 2018 who were lost to follow-up for >1 year and then returned to care.

Methods: Multivariable regression models were used to estimate odds ratios or relative risks and corresponding 95% confidence intervals.

Main outcome measures: Visual acuity (VA) and complications including diabetic macular edema, neovascular glaucoma, vitreous hemorrhage, and tractional retinal detachment.

Results: Visual acuity significantly worsened at the return visit (logarithm of the minimum angle of resolution [LogMAR] VA, 0.485 [approximately 20/60]) compared with the visit before lost to follow-up (LogMAR VA, 0.436 [approximately 20/55]; P < 0.001) but returned to baseline acuity at a year after return visit (LogMAR VA, 0.437 [approximately 20/55]). The average time from return visit to visit before lost to follow-up was 679 days. On return, newly diagnosed complications included diabetic macular edema (14.4%), neovascular glaucoma (0.5%), vitreous hemorrhage (8.4%), and tractional retinal detachment (3.3%). Panretinal photocoagulation monotherapy was associated with a lower risk of complications and a lower risk of final VA worse than 20/200.

Conclusions: Patients who are lost to follow-up develop serious vision-threatening complications and are at risk for vision loss when they return for care. Future efforts should aim to maximize adherence with treatment for PDR to prevent vision loss.