Patients Lost to Follow-up and Perspectives on Telehealth for Retinal Disease During COVID-19

During the COVID-19 pandemic, patients who received an intravitreal injection to treat neovascular age-related macular degeneration (nAMD) were much less likely to be lost to follow-up (LTFU) compared with all patients,¹ according to a poster presented at the American Society of Retina Specialists 40th Annual Scientific Meeting, held July 13-16, 2022, in New York, New York.

The researchers conducted a retrospective study analyzing 92,359 patients across 7 practices. Of the total patients, 6801 were diagnosed with nAMD and 3397 of those patients had received at least 1 intravitreal injection in a 12-month pre–COVID-19 period (March 1, 2019, to February 28, 2020). The data was analyzed to determine which patients never fulfilled another appointment between March 1, 2020, and December 31, 2021. Patients who did or left the practice were excluded from the LTFU cohort.

The patients who received nAMD injections and were lost to follow-up ranged from 8% to 16% across the 7 practices, for an average of 10.9%. In comparison, the range of total patients LTFU was 18% to 31%, for an average of 25.6%.

The researchers determined that patients who received an intravitreal injection for nAMD were 2.35 times less likely to be LTFU compared with all patients LTFU during the pandemic.

“The cause of 2.35x difference in LTFU rates is unknown but one can speculate that this could be due to the elderly and their family members having more time at home to reflect the seriousness of the condition and increased ability to find transportation to their appointments due to COVID-19,” they concluded.

Another study evaluating retinal care during the pandemic characterized patient attitudes toward telehealth for retinal disease.² There was a sharp growth in the use of telemedicine during the pandemic, and the researchers sought to understand the implications of the technology on patient satisfaction and the patient-physician relationship.

They distributed a cross-sectional survey to patients at University Retina in Illinois in July 2021. Responses were collected on a 5-point Likert scale with a ≥ 4 average rating for all questions defined as a positive attitude.

A total of 100 patients completed the survey. The majority (67%) of respondents were ≥ 65 years and 53.3% were female. Nearly half (46.6%) only had a high school diploma. While 21.4% of patients reported having diabetic retinopathy and 38.8% macular degeneration, 39.8% said they had no knowledge of their diagnosis. In addition, the majority (62.1%) had no history of telehealth usage.

The researchers found, overall, patients had a neutral attitude toward telehealth and that patients with prior telehealth were more likely to have a positive attitude compared with never users of telehealth (87.5% vs 71.8%; P = .046).

Overall, 69% said they preferred a traditional visit over telemedicine. The aspect of telemedicine with the most negative response was efficiency, followed by quality of care, and quality of assessment. The aspects with the most positive response were patient education, convenience, addressing patient concerns, and face time with the physician.

“Age, education status, and prior experience with telehealth are important factors to consider when adopting telehealth,” the researchers concluded. “Efforts to minimize the technological gap and other age-related barriers should be prioritized.”

References

1. Ginsburg L, Filoramo MR, Lam LA, Twomey-Allaire R, Petrucci A. Comparison of lost to follow-up rates between total ophthalmology patients vs patients receiving intravitreal injection treatment during COVID-19. Presented at: ASRS 40th Annual Scientific Meeting; July 13-16, 2022; New York, New York.

2. Bhaagt D, Chittaluru N, Patel P, Sheth V. Evaluating patient perspective regarding telehealth for retinal disease during the COVID-19 pandemic. Presented at: ASRS 40th Annual Scientific Meeting; July 13-16, 2022; New York, New York.