Infectious keratitis follow-up may depend on socioeconomic factors, symptom severity
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Key takeaways:
- Patients with government insurance were less likely to return in the recommended time frame.
- Those with worse visual acuity at presentation were more compliant with follow-up.
PHILADELPHIA — Symptom severity and socioeconomic factors may contribute to follow-up adherence in patients with infectious keratitis, according to a speaker.
“Few studies have looked at factors contributing to adherence with follow-up recommendations in patients diagnosed with infectious keratitis, and none of these have been carried out in the United States,” Pauline M. Dmitriev, MD, said at the Wills Eye Conference. “Our objective was to identify clinical and socioeconomic factors that contribute to noncompliance with initial follow-up after diagnosis of infectious keratitis at our institution.”
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Dmitriev and colleagues performed a retrospective chart review of patients diagnosed with infectious keratitis at Wills Eye between March 1 and Sept. 1, 2019.
Of the 288 patients reviewed, 99 were noncompliant with their respective follow-up recommendations. Patients with government insurance were less likely to follow up in the recommended time frame.
“We suppose that loss of wages associated with taking time off from work to present for an appointment may deter patients of lower income with government insurance from following up as recommended,” Dmitriev said.
Patients who were compliant with follow-up were more likely to have worse visual acuity at presentation, along with larger epithelial defect and infiltrate size and larger hypopyon. These visually bothersome and possibly painful factors may prompt stricter follow-up adherence.
Additionally, when patients were not cultured at the initial evaluation, they were less likely to present for follow-up as recommended.
“Culture status can be thought of as an indicator of infection severity, and less visually threatening corneal ulcers are less likely to be cultured,” Dmitriev said. “Patients with severe ulcers may receive more encouragement by physicians and family members to follow up appropriately, and patients might also be motivated to find out their pending culture results.”
Adhering to follow-up appointments is important due to the vision loss that can occur with infectious keratitis.
“The first follow-up appointment after diagnosis in particular is important to review available [microbiology] data, ensure that the current treatment is effective and prescribe additional therapies when needed,” Dmitriev said.
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Dmitriev PM, et al. Factors contributing to follow-up non-adherence after infectious keratitis diagnosis. Presented at: Wills Eye Conference; March 9-11, 2023; Philadelphia.
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