Research Identifies High-Risk Groups for Missing Diabetic Eye Disease Follow-Up Care

A study conducted by researchers from Unity Health, Sunnybrook Health Sciences Center, and the University of Toronto has revealed that certain demographics are more likely to miss essential follow-up care for diabetic eye disease. The findings indicate that male patients, as well as those identifying as Black or Hispanic, and individuals residing further away from treatment centers, are at an increased risk of not attending follow-up appointments, thereby heightening their chances of vision loss.

This research, published in JAMA Network Open, aims to enhance strategies to keep patients engaged in their care and improve management of diabetic retinopathy, the leading cause of vision impairment among individuals with diabetes. The condition arises from high blood sugar levels damaging the retina and impacts approximately one in four Canadians diagnosed with diabetes. If left untreated, diabetic retinopathy can lead to severe complications, including abnormal blood vessel growth and diabetic macular edema, which involves fluid leakage in the retina, both of which can cause significant vision deterioration.

Treatment options focus on preventing vision loss through techniques such as laser therapy and anti-VEGF (vascular endothelial growth factor) injections. Consistent follow-up and treatment are vital for maintaining patients' eyesight, as noted by a third-year medical student involved in the study.

The researchers analyzed electronic medical records of 2,961 patients treated from January 2012 to December 2021. They classified patients as lost to follow-up if they did not return to their specialist within one year after treatment. The study found that 17% of patients failed to follow up during the ten-year study period, with 41% permanently lost to follow-up and 54% returning at some point after the initial year.

Notably, male and Hispanic patients were found to be 20% to 50% more likely to miss follow-up appointments, while Black patients were twice as likely to experience gaps in their care. Additionally, those living more than 20 kilometers from their treatment facility were at higher risk of missing appointments, with this likelihood increasing with greater distances from the center.

Interestingly, patients with more severe conditions, such as worse baseline vision or diabetic macular edema, were less likely to miss follow-ups. The necessity for intensive treatment regimens likely incentivizes these patients to maintain regular appointments, especially as they observe significant improvements in their vision.

Furthermore, the study indicated that patients who received laser treatments tended to miss follow-ups more than those undergoing anti-VEGF injections. Although the effects of laser treatments are longer-lasting, neglecting follow-up care can elevate the risk of worsening vision over time.

For patients who temporarily missed follow-ups, preliminary findings suggest that those returning to clinics after a gap often experienced worse vision. While some patients who received laser treatments managed to regain pre-treatment eyesight levels, others treated with anti-VEGF injections did not fully recover their vision after resuming follow-up care.

In response to these concerning trends, the researchers propose several strategies to minimize the risk of patients being lost to follow-up. Suggestions include implementing automated reminders through text messages or phone calls for upcoming appointments, creating culturally and linguistically appropriate educational resources for patients, and coordinating appointments with transportation services to facilitate access for those living far from treatment centers.

Although this research specifically pertains to ophthalmology, the implications extend across various chronic diseases requiring regular management and follow-up.