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  • Comprehensive Ophthalmology, Pediatric Ophth/Strabismus

    Review of: Missed appointments in a tertiary academic pediatric ophthalmology and adult strabismus service: Cross-sectional study and literature review

    Law C, Yu C, Hawley G, et al. Journal of American Association for Pediatric Ophthalmology and Strabismus, April 2023

    Missed pediatric ophthalmology appointments can translate to poor vision care for the patient and lost hours and income for the ophthalmologist, but targeted strategies can help reduce no-show rates and ensure continuity of care.

    Study design

    Investigators conducted a cross-sectional study of 3922 consecutive patient visits to a Canadian academic hospital-based pediatric ophthalmology and strabismus practice between June 2018 and May 2019 to determine the rate of missed appointments (“no-shows”) and the factors associated with no-shows.


    Eighteen percent of scheduled visits were no-shows. The most significant factors associated with no-show appointments included nonsurgical diagnoses (odds ratio [OR] 3.2), history of previous no-shows (OR 2.2), referrals from nurse practitioners (OR 1.8), age 4–18 years (OR 1.6−1.8), and new patient status (OR 1.4). The high patient no-show rate translated into an average yearly time loss of 90 hours per ophthalmologist and an average lost physician billing cost of CAD $36,092 per ophthalmologist.


    This study was performed at a tertiary referral academic center in Canada, so these findings may not be generalizable to all types/settings of pediatric ophthalmology practice.

    Clinical significance

    Missed appointments are a serious barrier to patient care in pediatric ophthalmology because of the potential for lifelong vision loss without timely diagnosis and management. Not only patients suffer as a result of high no-show rates. This study's 18% no-show rate equated to 27 full clinic days lost per year. For a field that already has significant access issues, high no-show rates mean that waitlists will only continue to grow. Strategies to improve show rates, such as letters and phone calls, have had mixed results, and prior literature findings suggest that the inability to contact patients is the biggest obstacle to follow-up care in pediatric ophthalmology patients with low socioeconomic status. There is also a lack of awareness of the need for evaluation. Possible strategies to improve no-show rates include having hospitals implement patient reminder systems incorporating e-mails and text messaging and providing educational handouts to referring clinicians with a higher rate of no-show patients; the latter can help patients’ families better understand the reason for and importance of the referral. Given the ever-increasing demand for pediatric ophthalmology services, decreasing no-show rates is a cost-effective way to improve access.

    Financial Disclosures: Dr. Phoebe Lenhart discloses no financial relationships.