Factors associated with persistent vision loss in eyes with diabetic macular edema and non-proliferative diabetic retinopathy after lost-to-follow-up

PURPOSE: To determine factors associated with persistent vision loss among eyes with nonproliferative diabetic retinopathy (NPDR) and diabetic macular edema (DME) who return to care following loss to follow-up (LTFU). METHODS: This retrospective study was conducted at the Wills Eye Hospital/Mid Atlantic Retina between January 1st, 2015 and January 1st, 2023. Patients were included if they met the following study inclusion criteria I) ≥1 anti-VEGF injection before LTFU, II) history of LTFU for >6 months and, III) returned for care with ≥12 months of follow-up after LTFU. RESULTS: A total of 169 eyes of 169 patients met our inclusion criteria. Approximately 38% of eyes (N=64/169) worsened after returning to care, with ≥10-letter decline in VA compared to their pre-LTFU visit. At 12 months post-return, 27.2% (N=46/169) had a persistent ≥10-letter decrease in VA from their pre-LTFU baseline. On multivariable analysis, white race (OR 0.42, 95% CI: 0.20-0.92, p=0.03) was associated with decreased likelihood of ≥10 letter loss at the 12-month follow-up visit. VA at time of return (OR 6.47, 95% CI: 1.96-21.33, p=0.002) was also associated with vision loss at the 12-month visit. Increasing CFT at time of return (OR 1.004, 95% CI: 1.001-1.007, p=0.012) was the only factor associated with a ≥10 letter loss at the return visit. CONCLUSION: Approximately 1/4th of eyes had persistent vision loss at 1-year despite resumption of treatment. Race and VA upon return following LTFU were associated with vision loss at the 12-month visit. Increased macular edema was associated with vision loss at return visit.