Williams Andrew M, Liang Hai-Wei, Lin Hsing-Hua Sylvia
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Ophthalmol Glaucoma. 2025 May 8. doi: 10.1016/j.ogla.2025.05.001.
To assess the association between loss to follow-up (LTFU) and risk of incident blindness among a national registry cohort of patients with primary open-angle glaucoma (POAG).
Retrospective longitudinal cohort study.
Patients with a POAG diagnosis who had at least 2 visual acuity (VA) measurements documented in the IRIS® Registry (Intelligent Research in Sight) in both 2014 and 2019.
Loss to follow-up was defined as a calendar year or more without an encounter. Univariable and multivariable robust log-Poisson regression models were used to estimate the risk of incident blindness, with intervals of LTFU as the primary exposure of interest. Effect modification by baseline characteristics on the association between LTFU and incident blindness was also assessed.
Incident blindness in 1 or both eyes (VA ≤ 20/200) in 2019 among patients who were not blind in 2014.
Among the 149 172 patients, incident monocular blindness occurred in 6338 (4.2%), and incident binocular blindness occurred in 691 (0.5%) over the 6-year period. While most patients maintained follow-up every year (90%), 8.8% were LTFU for 1-2 years, and 1.1% were LTFU for 3-4 years. Patients with LTFU had greater risk of blindness. In an adjusted model that accounted for age, sex, race/ethnicity, insurance, smoking status, glaucoma severity, baseline intraocular pressure, baseline cup-to-disc ratio, and history of glaucoma surgery, risk of incident monocular blindness was greater among patients with a lapse of 1-2 years (adjusted relative risk [aRR] = 1.19, 95% confidence interval [CI]: 1.05-1.35) or a lapse of 3-4 years (aRR = 2.17, 95% CI: 1.66-2.78) compared to patients with no lapse in care. Race/ethnicity demonstrated a significant effect modification in the association between the longest lapse between encounters and the risk of blindness (P = 0.02). The risk of incident blindness after a lapse of 3-4 years (compared to no lapse) was higher among Black patients (aRR = 3.12, 95% CI: 2.06-4.76) than White patients (aRR = 1.93, 95% CI: 1.37-2.73). No effect modifications were identified by other baseline variables.
Loss to follow-up is an independent risk factor for incident blindness among patients with POAG. Lapses in care are particularly consequential for Black patients. Efforts to reduce LTFU may mitigate preventable glaucoma blindness.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
评估在一个全国性登记队列的原发性开角型青光眼（POAG）患者中，失访（LTFU）与失明风险之间的关联。
回顾性纵向队列研究。
在2014年和2019年的IRIS®登记系统（视力智能研究）中记录了至少2次视力（VA）测量值的POAG诊断患者。
失访定义为连续一整年或更长时间无就诊记录。使用单变量和多变量稳健对数泊松回归模型来估计失明风险，将失访间隔作为主要关注的暴露因素。还评估了基线特征对LTFU与失明之间关联的效应修正。
2014年未失明的患者在2019年一只或两只眼睛失明（VA≤20/200）。
在149172例患者中，6年期间单眼失明发生率为6338例（4.2%），双眼失明发生率为691例（0.5%）。虽然大多数患者每年保持随访（90%），但8.8%的患者失访1 - 2年，1.1%的患者失访3 - 4年。失访患者失明风险更高。在一个调整模型中，该模型考虑了年龄、性别、种族/民族、保险、吸烟状况、青光眼严重程度、基线眼压、基线杯盘比和青光眼手术史，与未失访患者相比，失访1 - 2年（调整后相对风险[aRR]=1.19，95%置信区间[CI]：1.05 - 1.35）或失访3 - 4年（aRR = 2.17，95% CI：1.66 - 2.78）的患者发生单眼失明的风险更高。种族/民族在就诊间隔最长与失明风险之间的关联中显示出显著的效应修正（P = 0.02）。失访3 - 4年后（与未失访相比），黑人患者失明风险（aRR = 3.12，95% CI：2.06 - 4.76）高于白人患者（aRR = 1.93，95% CI：1.37 - 2.73）。未发现其他基线变量有效应修正。
失访是POAG患者失明的独立危险因素。失访对黑人患者影响尤为严重。减少失访的努力可能会减轻可预防的青光眼失明。
在本文末尾的脚注和披露中可能会找到专有或商业披露信息。
