Nonproliferative diabetic retinopathy (NPDR) may represent an early stage of the disease, but it’s by no means a “safe zone” for affected individuals, as progression to proliferative forms is common and can yield complications such as tractional retinal detachment and neovascular glaucoma. Early screening and intervention is necessary to help reduce the chances of vision loss and blindness. Recent research suggests that in patients presenting to emergency departments with decreased vision due to NPDR, adherence to subsequent follow-up visits is low.

The retrospective study included 1,248 patients who presented to Bascom Palmer’s ophthalmic emergency department with NPDR between May 2014 and December 2018. The researchers analyzed demographic and encounter data. They defined adherence to follow-up as a completed encounter within five weeks of the recommended follow-up.

The follow-up rate was 53% among the entire cohort. The researchers found that the following factors were significantly associated with decreased odds of adhering to follow-up: longer physician-recommended follow-up intervals, longer interval to scheduled appointment, commercial insurance and lack of insurance. On the other hand, factors significantly associated with increased odds of patient adherence were longer emergency department duration, farther home distance, increased likelihood of living in a higher income area, greater NPDR severity, Medicare, presence of macular edema and worse vision.

“Although NPDR affects certain demographic groups more than others, once diagnosed with NPDR, patient demographics in general don’t have a significant impact on follow-up adherence,” the researchers wrote in their paper. “Rather, disease-specific characteristics such as more severe NPDR, vision loss and the presence of DME are associated with increased follow-up adherence. Extra care should be taken when considering follow-up adherence of patients with less severe visual symptoms.”

“This study highlights the need for careful management of populations at high risk for loss to follow-up,” they concluded. They pointed out that interventions, including text and phone call reminders, shorter follow-up intervals and more deliberate patient education, have been demonstrated to improve health care access and reduce socioeconomic and racial disparities.

Watane A, Kalavar M, Vanner EA, et al. Follow-up adherence in patients with nonproliferative diabetic retinopathy presenting to an ophthalmic emergency department. Retina. 2021;41:1293-301.