Compliance is a big issue when it comes to PDR patients treated with anti-VEGF injections. Photo: Julie Torbit, OD.

Ranibizumab is known as the best treatment for proliferative diabetic retinopathy (PDR), but it requires constant monitoring and frequent injections, which could cause lapses in patient care. In a recent study, researchers investigated these lapses among patients on this treatment.

Through five years of follow-up, 94 of 170 participants (55.3%) had at least one or more long lapses in care when they were late for their next scheduled appointment by eight or more weeks.

“Among the approximately 50% of participants who had a long lapse in care, the proportion of individuals with a loss of visual acuity of 15 or more letters was higher than in participants without a long lapse (14% vs 3%, respectively); however, it is unclear whether these worse outcomes resulted from missed visits or were related to patient and/or eye characteristics that were more prevalent among participants who miss visits,” the authors noted.

Approximately 30% of participants dropped out after five years, and only 15% completed all examinations without any lapses.

Participants with worse visual acuity, presence of both neovascularization of the disc and elsewhere and no prior history of laser treatment for diabetic macular edema were more likely to have a long lapse in care, but these factors were not highly predictive of who would later have a long lapse.

“The cumulative probability of a lapse increased through the five-year follow-up period, implying that a past record of timely visits did not ensure timely future visits,” the authors explained. “Nonetheless, 90% of participants returned after their first lapse.”

The authors concluded that the likelihood of a lapses in care after initial treatment and during long-term follow-up should be considered when choosing treatment for PDR.

Maguire MG, Liu D, Bressler SB, et al. Lapses in care among patients assigned to ranibizumab for proliferative diabetic retinopathy. JAMA Ophthalmol. October 21, 2021. [Epub ahead of print].