Predictors and Patient-Reported Reasons for Missed Appointments in an Urban Ophthalmology Center

Purpose To examine adult ophthalmology appointments at New York Eye and Ear Infirmary of Mount Sinai (NYEE) to identify structural and logistical factors associated with no-shows.Methods We conducted a retrospective cross-sectional mixed-methods study of electronic health record data for adult appointments between January 1 and December 31, 2025 (n = 62,678). Demographic, socioeconomic, geographic, and appointment characteristics were extracted from the electronic health record. Generalized estimating equations were used to identify predictors of no-show while accounting for repeated appointments by the same patient. A subset of glaucoma patients who missed appointments participated in routine quality improvement follow-up calls documenting reasons for missed visits. The primary outcome was appointment attendance; the secondary outcome was patient-reported reasons for missed appointments.Results The overall no-show rate was 16.9%. Medicaid/Public insurance, Self-Pay/Charity status, higher neighborhood social vulnerability, afternoon appointments, and several ophthalmic subspecialties were independently associated with greater odds of no-show. Younger age was also associated with increased no-show risk, whereas travel distance was not associated with a clinically meaningful increase in missed appointments. Among 67 patients reached through follow-up calls, the most commonly reported reasons for missed visits were forgetting the appointment, health or family emergencies, and scheduling conflicts.Conclusion Missed ophthalmology appointments are driven by both structural socioeconomic disadvantage and immediate logistical barriers. Combining large-scale electronic health record analyses with patient-reported perspectives supports the development of targeted, equity-focused interventions.