Nearly 1 in 5 wet AMD patients lost to follow-up after anti-VEGF injections
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Study results showed a high rate of loss to follow-up in patients with neovascular age-related macular degeneration treated with anti-VEGF injections in the U.S., with nearly 1 in 5 patients lost to follow-up.
“Because retina clinics are often overwhelmed by patients requiring intravitreal injections, it’s easy to overlook patients who do not regularly follow-up and eventually are lost to follow-up,” Rahul N. Khurana, MD, vitreoretinal surgeon with of Northern California Retina Vitreous Associates Medical Group Inc., said during his presentation at the virtual American Society of Retina Specialists meeting.
“The Wills Eye group looked at this problem and found that when they defined loss to follow up as no visit greater than 12 months after an intravitreal injection, [there was] a very high rate in neovascular AMD reaching nearly 22% among the 9,000 patients studied in a large private practice with 13 clinical sites,” Khurana said. “We wanted to see if this experience at Wills was representative of a national group.”
In a retrospective cohort analysis involving 292,080 patients with neovascular AMD, Khurana and colleagues examined the incidence of loss to follow up in patients treated with anti-VEGF injections in the U.S. and identified associated risk factors. The study included patients diagnosed with AMD from 2013 to 2015 and treated with anti-VEGF therapy between 2013 and 2018. The investigators performed multivariable logistic regression analysis involving baseline demographic and clinical conditions.
Overall, 20.14% of patients with neovascular AMD were lost to follow-up, 78.62% of patients had a follow-up within 12 months and 1.24% of patients who were lost to follow-up did have later follow-up, according to the presentation.
“There’s a high rate of loss to follow-up in patients with neovascular AMD in the United States, with nearly 1 in 5 patients lost to follow-up,” Khurana said. “Risk factors include increasing age, male sex, unreported ethnicity, unilateral involvement, private insurance, government/military insurance had a higher rate of being loss to follow-up.”
The results showed that compared with patients aged 70 years and younger, the risk for loss to follow-up were greater among patients:
- aged 76-80 years (OR = 1.252; 95% CI, 1.302-1.302);
- aged 81-85 years (OR = 1.252; 95% CI, 1.203-1.302);
- aged 86-90 years (OR = 1.436; 95% CI, 1.381-1.483); and
- aged older than 90 years (OR = 1.681; 95% CI, 1.613-1.751).
The risk for loss to follow-up was lower for women (OR = 0.897; 95% CI, 0.879-0.915) than men, and the risk among Hispanic patients (OR = 1.167; 95% CI, 1.105-1.234) and those of unreported race (OR = 3.025; 95% CI, 2.943-3.109) were greater than the risk among white patients.
Further, risk for loss to follow-up in patients with baseline visual acuity of 20/50 to 20/200 (OR = 1.214; 95% CI, 1.187-1.242) were greater than in patients with baseline visual acuity of 20/40 or better, and the risk for loss to follow-up with bilateral involvement (OR = 0.145; 95% CI, 0.142-0.149) were less than unilateral involvement, according to the findings.
“Improving adherence is key to optimizing long-term outcomes. It really illustrates the importance in patients in maintaining and developing new strategies to have patients follow-up with care,” Khurana said. “It will require more patient-centered strategies to motivate patients to continue their care and ultimately to optimize their outcomes and management of AMD.”
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Khurana RN, et al. Loss to follow-up in patients with neovascular age-related macular degeneration treated with anti-VEGF therapy in the United States. Presented at: American Society of Retina Specialists annual meeting; July 24-26, 2020 (virtual meeting).
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