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  • Lapses in Care for PDR After Anti-VEGF Tx

    By Jean Shaw
    Selected and Reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, December 2021

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    Maguire et al. set out to assess whether examinations of patients assigned to intravitreal injections of ranibizumab for proliferative diabetic retinopathy (PDR) in a randomized controlled trial were completed as scheduled. They found that, over a five-year period, ap­proximately half of the participants had long lapses in care, and nearly a third dropped out of the study, despite efforts of the DRCR Retina Network to ensure that all examinations were completed on time.

    For this post hoc analysis, the researchers evaluated data from the DRCR Network’s Protocol S, which was completed in 2015. Main outcomes were a long lapse in care of eight or more weeks past a scheduled exam­ination, dropout from follow-up, and visual acuity (VA) at five years.

    Of 191 participants with an eye assigned to ranibizumab, 21 died during the follow-up period. Of the remaining 170 participants, the median age at baseline was 51 (44-59 years), and 76 (44.7%) were female. During the five years of follow-up, 26 participants (15.3%) were fully compliant, with no lapses in care. For the remainder, the median number of episodes of any lapse in care was three (range, 0-16), and 63 patients (37.1%) had four or more lapses in care.

    For 14 patients (9.7%), the first lapse in care resulted in dropping out entirely from the study. By the five-year mark, 50 participants (29.4%) had dropped out. Among the remaining 120 partici­pants, the median change from baseline in VA was a loss of 2 letters for those who had one or more long lapses in care. In contrast, those without a long lapse in care gained a median of 5 letters (p = .02). However, the research­ers noted, it is unclear whether the patients’ poor outcomes in VA resulted from missed visits or were related to patient and/or eye characteristics that were more prevalent among those who missed visits.

    In their discussion, the authors noted that most (90%) of participants returned for at least one appointment after their first lapse in care. Given that finding, they said, clinicians may have opportunities to counsel returning patients on why regular follow-up is essential to maximizing visual out­comes.

    The original article can be found here.