Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, 51 North 39th St, Philadelphia, PA, 19104, USA.
Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
Graefes Arch Clin Exp Ophthalmol. 2021 Jun;259(6):1419-1425. doi: 10.1007/s00417-020-04944-w. Epub 2020 Sep 30.
To quantify the association between visit adherence and visual acuity (VA) in diabetic macular edema (DME).
This secondary analysis of the 2-year DRCRnet Protocol T study of 656 patients required one visit every 4 weeks in the first year, then at variable 4-16-week intervals in the second year. Visit adherence measured as number of missed visits, average (avg days) and longest (max days) visit interval, average (avg missed days) and longest (max missed days) unintended visit interval, and visit constancy (percentage of 3-month periods with at least 1 visit). Avg and max missed days were categorized as on time (0 days), late (> 0-60 days), and very late (> 60 days). Primary outcome was change in ETDRS VA between baseline study visit and last attended visit, using multivariate linear regression models controlling for age, gender, race, ethnicity, treatment arm, baseline VA, hemoglobin A1c, insulin use, and number of lasers and injections.
Mean number of missed visits was 1.7. 616 (94%) patients had 100% visit constancy. A total of 331 (51%) patients were on time, 171 (26%) late, and 154 (23%) very late in avg missed days. Max missed days ranged 0-696 days. Adjusted, each missed visit was associated with 0.3-letter decrease (95%CI - 0.6, - 0.1, p = 0.02); being very late in avg and max missed days saw - 4.2 letters (95%CI - 6.4, - 2.0, p < 0.001) and - 4.0 letters (95%CI - 6.1, - 1.9, p < 0.001), respectively, than on time. Those that averaged > 4 days missed per attended visit saw 4.6 letters worse (95%CI - 7.3, - 2.0, p < 0.001).
Visit adherence is associated with visual acuity outcomes in DME patients.
定量研究糖尿病黄斑水肿（DME）患者就诊依从性与视力（VA）之间的关系。
本研究为 DRCRnet 协议 T 研究的二次分析，共纳入 656 例患者，研究时间为 2 年。在研究的前 1 年，患者每 4 周就诊 1 次，第 2 年的就诊间隔为 4-16 周不等。通过错过就诊次数、平均（avg days）和最长（max days）就诊间隔、平均（avg missed days）和最长（max missed days）非计划就诊间隔以及就诊稳定性（3 个月期间至少就诊 1 次的比例）来评估就诊依从性。将平均错过就诊天数分为按时（0 天）、延迟（0-60 天）和严重延迟（>60 天）。主要结局是使用多元线性回归模型，在控制年龄、性别、种族、民族、治疗组、基线 VA、糖化血红蛋白、胰岛素使用以及激光和注射次数的情况下，比较基线研究就诊时和最后一次就诊时的 ETDRS VA 变化。
平均错过就诊次数为 1.7 次。616 例（94%）患者就诊稳定性为 100%。331 例（51%）患者按时就诊，171 例（26%）延迟就诊，154 例（23%）严重延迟就诊。平均错过就诊天数为 0-696 天。调整后，每次错过就诊与视力下降 0.3 个字母相关（95%CI - 0.6，- 0.1，p = 0.02）；与按时就诊相比，平均和最长错过就诊天数严重延迟的患者视力分别下降 4.2 个字母（95%CI - 6.4，- 2.0，p < 0.001）和 4.0 个字母（95%CI - 6.1，- 1.9，p < 0.001）。与每次按时就诊相比，每次就诊错过平均就诊时间 4 天以上的患者视力下降 4.6 个字母（95%CI - 7.3，- 2.0，p < 0.001）。
DME 患者的就诊依从性与视力结局相关。
