Researchers from Texas report one out of six patients with proliferative diabetic retinopathy (DR) don’t follow clinical recommendations or miss scheduled appointments that result in a lag of up to six months until they see their doctor again, and the main reason for their non-compliant behavior is insurance status.

Their study, published in the American Journal of Ophthalmology, included 4,423 patients with proliferative DR between 2012 and 2017. Patients were defined as “complete loss to follow up” if they never returned in the study period. Individuals were considered “interval loss to follow up” if they didn’t adhere to clinical recommendations or missed scheduled appointments resulting in longer than six months or one year between two appointments. The study also considered age, average gross income and insurance status as potential influencers of non-compliance.

The investigation reported more than half of patients were completely lost to follow up at six months and one year, respectively (54.4% and 52.4%). The trend of interval loss to follow up for six months and a year numbers were lower: 17.7% and 10.6%, respectively.

Researchers noted one out of 10 patients were interval loss to follow up for more than one year.

“Loss to follow-up is a major challenge to delivering appropriate care for patients with diabetic retinopathy,” says investigator Charles Wykoff, MD, PhD. “Because the blindness attributable to PDR is arguably almost completely preventable, the scale of the associated permanent visual loss across our society is particularly notable and symbolizes the shortcomings in how we diagnose and manage this disease. Much more work is needed to better understand and ultimately break down hurdles preventing patients from receiving appropriate care for diabetic retinopathy.”

Age and average gross income didn’t appear to be significant predictors of interval loss to follow up status.

Compared with self-pay, government and private insurance patients were more likely to be interval loss to follow up at six months. Private insurance patients were also more likely to be interval loss to follow up at one year.