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Visit adherence and visual acuity outcomes in patients with diabetic macular edema: a secondary analysis of DRCRnet Protocol T

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To quantify the association between visit adherence and visual acuity (VA) in diabetic macular edema (DME).

Methods

This secondary analysis of the 2-year DRCRnet Protocol T study of 656 patients required one visit every 4 weeks in the first year, then at variable 4–16-week intervals in the second year. Visit adherence measured as number of missed visits, average (avg days) and longest (max days) visit interval, average (avg missed days) and longest (max missed days) unintended visit interval, and visit constancy (percentage of 3-month periods with at least 1 visit). Avg and max missed days were categorized as on time (0 days), late (> 0–60 days), and very late (> 60 days). Primary outcome was change in ETDRS VA between baseline study visit and last attended visit, using multivariate linear regression models controlling for age, gender, race, ethnicity, treatment arm, baseline VA, hemoglobin A1c, insulin use, and number of lasers and injections.

Results

Mean number of missed visits was 1.7. 616 (94%) patients had 100% visit constancy. A total of 331 (51%) patients were on time, 171 (26%) late, and 154 (23%) very late in avg missed days. Max missed days ranged 0–696 days. Adjusted, each missed visit was associated with 0.3-letter decrease (95%CI − 0.6, − 0.1, p = 0.02); being very late in avg and max missed days saw − 4.2 letters (95%CI − 6.4, − 2.0, p < 0.001) and − 4.0 letters (95%CI − 6.1, − 1.9, p < 0.001), respectively, than on time. Those that averaged > 4 days missed per attended visit saw 4.6 letters worse (95%CI − 7.3, − 2.0, p < 0.001).

Conclusions

Visit adherence is associated with visual acuity outcomes in DME patients.

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Data availability

Data are available in a public, open access repository: The DRCRnet Protocol T Public Dataset, accessible at https://public.jaeb.org/drcrnet/stdy/206

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Funding

This work was supported by National Institutes of Health (1K23EY025729-01), University of Pennsylvania Core Grant for Vision Research (2P30EY001583), and block research grants to the Scheie Eye Institute from the Research to Prevent Blindness, the Paul and Evanina Mackall Foundation, and the Karen and Herbert Lotman Fund for Macular Vision Research Foundation.

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Authors and Affiliations

  1. Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, 51 North 39th St, Philadelphia, PA, 19104, USA

    Meera S. Ramakrishnan & Brian L. VanderBeek

  2. Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA

    Yinxi Yu

  3. Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA, USA

    Brian L. VanderBeek

  4. Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA

    Brian L. VanderBeek

Authors
  1. Meera S. Ramakrishnan
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  2. Yinxi Yu
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  3. Brian L. VanderBeek
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Contributions

All authors contributed to study conception and design. Data collection and analysis were performed by Meera Ramakrishnan, Yinxi Yu, and Brian VanderBeek. The first draft of the manuscript was written by Meera Ramakrishnan, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Brian L. VanderBeek.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study adhered to the tenets put forth in the 1964 Declaration of Helsinki. Institutional review board by the University of Pennsylvania was not required as it was conducted on freely available public data.

Consent to participate

Informed consent for this secondary analysis was not required as the data are deidentified and freely available online.

Consent for publication

Consent for publication for this secondary analysis was not required as the data are deidentified and freely available online.

Code availability

Code used for data analysis can be provided by contacting the corresponding author.

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Ramakrishnan, M.S., Yu, Y. & VanderBeek, B.L. Visit adherence and visual acuity outcomes in patients with diabetic macular edema: a secondary analysis of DRCRnet Protocol T. Graefes Arch Clin Exp Ophthalmol 259, 1419–1425 (2021). https://doi.org/10.1007/s00417-020-04944-w

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  • DOI: https://doi.org/10.1007/s00417-020-04944-w

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