2025-08-08 トロント大学(U of T)
<関連情報>
- https://www.utoronto.ca/news/study-suggests-who-most-risk-missing-critical-follow-care-diabetic-eye-disease
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828027
増殖性糖尿病性網膜症または糖尿病性黄斑浮腫の患者における追跡調査の喪失 Loss to Follow-Up in Patients With Proliferative Diabetic Retinopathy or Diabetic Macular Edema
Ryan S. Huang, MSc; Sumana C. Naidu, MD; Andrew Mihalache; et al
JAMA Network Open Published:December 13, 2024
DOI:10.1001/jamanetworkopen.2024.50942
Key Points
Question What is the lost to follow-up (LTFU) rate of patients receiving treatment for proliferative diabetic retinopathy or diabetic macular edema and what factors are associated with LTFU rates?
Findings In this cohort study of 2961 patients with proliferative diabetic retinopathy or diabetic macular edema, 17% were LTFU. Higher odds of LTFU were found among males, patients living further from the point of care, patients who were Black or Hispanic, patients receiving panretinal photocoagulation (vs anti–vascular endothelial growth factor intravitreal injections), and patients with lower intravitreal injection burden.
Meaning The findings of this study identified risk factors associated with LTFU that could help to inform targeted strategies to reduce these rates.
Abstract
Importance Effective management of proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) requires reliable patient follow-up to prevent disease progression.
Objective To investigate the sociodemographic and clinical factors associated with being lost to follow-up (LTFU) among individuals with PDR or DME treated with anti–vascular endothelial growth factor (VEGF) intravitreal injections (IVIs) or panretinal photocoagulation (PRP).
Design, Setting, and Participants This cohort study included a multicenter, retrospective review of patients with PDR or DME treated in Toronto, Canada, from January 1, 2012, to December 31, 2021. Data were analyzed from February 1 to May 31, 2024.
Exposures All patients received at least 1 anti-VEGF IVI or PRP session.
Main Outcomes and Measures The primary outcome was the LTFU rate, defined as the absence of an ophthalmic visit or intervention in the 1-year period following an individual’s last visit with the treating retinal specialist. Univariable and multivariable logistic regression models were conducted to evaluate associations between sociodemographic and clinical factors with the LTFU rate.
Results Overall, 2961 patients with PDR or DME (mean [SD] age, 71 [13] years; 1640 [55.4%] male) were included, of whom 507 (17.1%) were LTFU over a mean (SD) follow-up period of 61 (22) months. In the multivariable analysis, older patients (age ≥85 years vs age <65 years: odds ratio [OR], 0.58; 95% CI, 0.40-0.81; P = .002), those with worse baseline visual acuity (>20/200 Snellen vs 20/40 Snellen or better: OR, 0.68; 95% CI, 0.48-0.97; P = .04), those with DME (OR vs no DME, 0.60; 95% CI, 0.43-0.83; P = .003), those with frequent clinic visits (≥6 visits vs <6 visits: OR, 0.78; 95% CI, 0.62-0.98; P = .04), and those with a high anti-VEGF IVI burden in the first year (OR vs low anti-VEGF burden, 0.40; 95% CI, 0.21-0.76; P = .006) were less likely to be LTFU. In contrast, males (OR vs females, 1.23; 95% CI, 1.04-1.52; P = .04), patients living further from the point of care (>200 vs ≤20 km OR, 2.65; 95% CI, 1.85-3.76; P < .001), and those treated with PRP (OR vs anti-VEGF IVIs, 2.10; 95% CI, 1.24-3.55; P < .001) were more likely to be LTFU. Compared with White patients, Black patients (OR, 2.10; 95% CI, 1.50-2.95; P < .001) and Hispanic patients (OR, 1.54; 95% CI, 1.05-2.21; P = .03) were more likely to be LTFU.
Conclusions and Relevance This cohort study found multiple factors associated with LTFU rates. Identifying individuals at higher risk of LTFU and developing targeted strategies may reduce disease progression and vision loss in individuals with PDR.
