Loss to Follow-up Among Patients With Neovascular Age-Related Macular Degeneration Who Received Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Importance: Loss to follow-up (LTFU) after anti-vascular endothelial growth factor (anti-VEGF) injections increases the risk of vision loss among patients with neovascular age-related macular degeneration (nAMD). Objective: To report rates of LTFU among patients with nAMD after anti-VEGF injections and to identify risk factors associated with LTFU in this population. Design, Setting, and Participants: This retrospective cohort study of data from 9007 patients who received anti-VEGF injections for treatment of nAMD was performed at an urban, private retina practice with multiple locations from April 1, 2012, to January 12, 2016. Main Outcomes and Measures: Rates of LTFU after anti-VEGF injections. Loss to follow-up was defined as receipt of 1 or more injections with no subsequent follow-up visit within 12 months. Results: Among the 9007 patients (mean SD age, 81. 2 8. 8 years; 5917 65. 7% female; 7905 87. 8% white), 2003 (22. 2%) were LTFU. Odds of LTFU were greater among patients 81 to 85 years of age (odds ratio OR, 1. 58; 95% CI, 1. 38-1. 82; P <. 001), 86 to 90 years of age (OR, 2. 29; 95% CI, 2. 00-2. 62; P <. 001), and more than 90 years of age (OR, 3. 31; 95% CI, 2. 83-3. 86; P <. 001) compared with patients 80 years of age and younger. Odds of LTFU among African American patients (OR, 1. 47; 95% CI, 1. 00-2. 16; P =. 05), Asian patients (OR, 2. 63; 95% CI, 1. 71-4. 03; P <. 001), patients of other race (OR, 3. 07; 95% CI, 1. 38-6. 82; P =. 006), and patients of unreported race (OR, 2. 29; 95% CI, 1. 96-2. 68; P <. 001) were greater than odds of LTFU among white patients. Odds of LTFU were greater among patients with regional adjusted gross income of 50 000 or less (OR, 1. 52; 95% CI, 1. 30-1. 79; P <. 001), 51 000 to 75 000 (OR, 1. 35; 95% CI, 1. 17-1. 56; P <. 001), and 76 000 to 100 000 (OR, 1. 28; 95% CI, 1. 08-1. 50; P =. 004) compared with patients with incomes greater than 100 000. Odds of LTFU for patients living 21 to 30 miles (OR, 1. 33; 95% CI, 1. 05-1. 69; P =. 02) and more than 30 miles (OR, 1. 55; 95% CI, 1. 28-1. 88; P <. 001) from clinic were greater compared with patients who lived 10 miles or less from the clinic. Odds of LTFU were greater among patients who received unilateral injections (OR, 1. 44; 95% CI, 1. 28-1. 61; P <. 001) than among patients who received bilateral injections. Conclusions and Relevance: We found a high rate of LTFU after anti-VEGF injections among patients with nAMD and identified multiple risk factors associated with LTFU among this population. Although our results may not be generalizable, data on LTFU in a clinical practice setting are needed to understand the scope of the problem so that interventions may be designed to improve outcomes.