This single-center retrospective study examined rates of loss to follow-up in patients with proliferative diabetic retinopathy (PDR) who had received laser photocoagulation or intravitreal anti-VEGF injections.
Study design
Researchers studied 2,302 patients with PDR who had received panretinal photocoagulation (PRP) or anti-VEGF therapy. Loss to follow-up was defined as a gap of more than 12 months immediately following anti-VEGF or PRP.
Outcomes
Of 1,718 patients, 584 (25.4%) did not return for a follow-up visit during the 4-year study period. A significantly higher proportion of patients in the laser group were lost to follow-up compared with the anti-VEGF group (28% vs. 22%; P<0.001)
Whites (19.4%) and Asians (19.7%) were lost to follow-up less often than African-Americans (30.2%) or Hispanics/Native Americans/Pacific Islanders (38%). Other risk factors included younger age and residence in areas with lower average adjusted gross income.
Limitations
This study reported the experiences of only 1 large retina group located in the Northeast region of the United States. The authors did not consider the implications of early versus late PDR, and there was a wide spectrum of vision impairment in this group. Loss to follow-up was based on a 12-month gap in care; rates may have been higher with a shorter gap. The treating physicians chose the patients who received PRP versus anti-VEGF, and this potential selection bias may help explain the differences between these 2 groups.
Clinical significance
PDR patients are at risk for being lost to follow-up. This study demonstrates a fairly high real-world loss to follow-up rate, which is concerning. Key risk factors included age, race and regional average gross income.
The DRCR.net’s Protocol S and UK CLARITY trials demonstrated that anti-VEGF monotherapy is non-inferior or superior to PRP for treating patients with PDR. However, the gap in care may have been more impactful on patients treated with anti-VEGF, as PRP has lasting effects on regression of neovascularization. In clinical practice, choice of treatment for PDR must be carefully weighed, particularly if anti-VEGF monotherapy is initiated. Measures should be taken to decrease loss to follow-up after either therapy.