Goal of glaucoma specialists should be not only diagnosis, but also retention

Alan L. Robin

NUSA DUA, Indonesia — Glaucoma specialists both in developed and developing countries must aim to not only diagnose the disease, but retain patients through ongoing follow-up, a surgeon said here.

"Screening methods are important, but we need to keep people in the system," Alan L. Robin, MD, said during the joint meeting of the Asia-Pacific Academy of Ophthalmology and American Academy of Ophthalmology.

"We recently did a case control individual study ... trying to predict the barriers to follow-up and predictors of poor follow-up," Dr. Robin said.

Presenting unpublished data collected from the Aravind Eye Hospital in India, Dr. Robin and his colleagues looked at 150 controls that had good follow-up and 150 cases that had poor follow-up.

Predictors of poor follow up were a lack of formal education, no use of prescribed glaucoma medications and belief that follow-up is less important if one uses medications yet has no noticeable visual changes. The most significant barriers to follow-up were belief that there was no problem with one's eyes and lack of an escort.

"Obviously if you get somebody in the system, if you find these people, if you learn how to overcome these barriers, we can prevent blindness, right? The answer is no," Dr. Robin said.

Despite being introduced to the system, a maximum of one-third of patients returned within 1 year of diagnosis. Over the course of the 3 years studied, loss to follow-up increased as patient volume increased, decreasing the time physicians spent with each individual patient.

"Once these people are picked up, they are lost to follow-up, so getting somebody into the system isn't the only answer. We have to suggest that our best hope to improve loss of follow-up — and I think this is probably universal — is in the initial visit. You have to make your most important impact there," Dr. Robin said.