Loss to Follow-up in Patients with Neovascular Age-Related Macular Degeneration Treated with Anti–VEGF Therapy in the United States in the IRIS® Registry

Purpose

To determine the incidence of being lost to follow-up (LTFU) and nonpersistence in patients with neovascular age-related macular degeneration (AMD) treated with anti–VEGF injections in the United States.

Design

Retrospective cohort study using the IRIS® (Intelligent Research in Sight) Registry data.

Participants

One hundred fifty-six thousand three hundred twenty-seven treatment-naive patients with neovascular AMD who subsequently were treated with anti-VEGF therapy from 2013 through 2015 and followed up through 2019.

Methods

Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Main Outcome Measures

Being LTFU was defined as no follow-up within 12 months from last intravitreal injection. Nonpersistence was defined as no follow-up within 6 months from last intravitreal injection.

Results

For neovascular AMD, 11.6% of patients (95% CI, 11.4%–11.7%) were LTFU, and 88.4% of patients were followed up within 12 months. The rate of being LTFU generally was higher with increasing age, with odds of being LTFU greatest for patients between 81 and 84 years of age (OR, 2.51; 95% CI, 2.31–2.74; P < 0.001) compared with patients 70 years of age and younger. Odds of being LTFU for Black or African American patients (OR, 1.32; 95% CI, 1.08–1.61; P = 0.007) were greater than for White patients. Odds of being LTFU were higher for patients with Medicaid insurance (OR, 1.27; 95% CI, 1.01–1.60; P = 0.04) and lower for patients with Medicare Fee-For-Service insurance (OR, 0.69; 95% CI, 0.64–0.74; P < 0.001) than for patients with private insurance. Furthermore, 14.3% (95% CI, 14.1–14.4) of patients were nonpersistent, and 85.7% of patients underwent follow-up within 6 months. Odds of nonpersistence also were greatest among patients between 81 and 84 years of age (OR, 2.13; 95% CI, 1.98–2.29; P < 0.001) compared with patients 70 years of age or younger. Odds of nonpersistence for Black or African-American patients (OR, 1.38; 95% CI, 1.15–1.65; P < 0.001) and Hispanic patients (OR, 1.13; 95% CI, 1.03–1.24; P = 0.009) were greater than odds for White patients.

Conclusions

Nearly 1 of 9 patients with neovascular AMD treated with anti-VEGF injections became LTFU, whereas 1 of 7 patients were nonpersistent. Risk factors identified included increasing age, male sex, unilateral involvement, diabetes, Medicaid insurance, and race or ethnicity.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.