Does Poor Visit Adherence Cause Vision Loss in Older Patients?
Missing just one ophthalmology appointment can cause vision loss for patients with age-related macular degeneration, highlighting the need for visit adherence, according to results from a Penn Medicine study published JAMA Ophthalmology.
Data from the Comparison of Age-related Macular Degeneration Treatment Trail (CATT) randomized clinical trial was analyzed. Patients were required to visit an ophthalmologist at least once every 4 weeks for a total of 26 visits for treatment as needed. Visit adherence was measured by total number of missed visits, average number of days between each visit, longest duration in days (max days) between visits, and visit constancy (the total of 3-month periods with at least 1 visit attended). Metrics were compared to the outcomes of the patient’s final vision test were compared.
Better visual outcomes were found across all metrics in patients who best adhered to their visit schedule. An average visual acuity letter score decline of 0.7. was associated with each missed visit. Compared to patients who attended all of visits, patient who averaged between 36 to 60 days between visits lost 6.1 letters, and those who went more than 60 days between visits lost 12.5 letters.
“Research of other diseases has shown the importance of appointment adherence. In patients with HIV, for example, studies have found that showing up to appointments has been linked to lower mortality rates and reduced viral loads. But unlike HIV patients, who can have prescriptions filled over the phone by any physician, anti-VEGF therapy can only be administered by an ophthalmologist, making visit adherence even more critical for those with macular degeneration,” said Brian VanderBeek, MD, a professor of Ophthalmology at the University of Pennsylvania’s Perelman School of Medicine in a press release. “I wanted to quantify the link between regular visits to the eye doctor and visual outcomes for these patients.”
Ramakrishnan MS, Yu Y, VanderBeek B. Association of visit adherence and visual acuity in patients with neovascular age-related macular degeneration. JAMA Ophthalmol. 2020. Epub ahead of print. doi:10.1001/jamaophthalmol.2019.4577