Risk factors and consequences of lapses in proliferative diabetic retinopathy care in a national cohort

<p dir="ltr">Objective</p><p dir="ltr">To identify prevalence, risk factors, and visual outcomes associated with occurrence and duration of lapses in proliferative diabetic retinopathy (PDR) care.</p><p><br></p><p dir="ltr">Research Design and Methods</p><p dir="ltr">Retrospective national cohort study (2008-2023) of adults with PDR and ≥6 months of follow-up in the Sight Outcomes Research Collaborative (SOURCE). We used multivariable regressions to assess factors associated with lapse occurrence and duration, and compared post-lapse visual acuity by lapse duration. </p><p><br></p><p dir="ltr">Results</p><p dir="ltr">Among 15211 individuals, 71.8% experienced a lapse in care; 14.2% lasted >24 months. Lapses were more common among non-Hispanic Black, younger, and disabled individuals, and less common in those with poor vision or prior PDR treatment. Older age and PDR treatment predicted shorter lapses, and residence in distressed areas predicted longer lapses. Visual acuity worsened following lapses, with greater declines after longer lapses.</p><p><br></p><p dir="ltr">Conclusions</p><p dir="ltr">Prolonged lapses in PDR care are common, disproportionately affect vulnerable groups, and associated with persistent vision loss.</p>