Background
Healthcare disparity is the United States has been a long-standing issue. A disease of interest is diabetic retinopathy, one of the leading causes of blindness in the United States, as the minorities are disproportionately affected. Treatment regimens often consist of panretinal photocoagulation (PRP) and intravitreal injections (IVI) with anti-vascular endothelial growth factor (anti-VEGF). However, the efficacy of the treatment regimens as demonstrated in clinical trials have been limited in real-world settings as these necessitate frequent follow-ups, a challenge given that 25 to 51% of patients with diabetic retinopathy are lost to follow-ups. Furthermore, the effect of LTFU in itself on final outcomes have not been studied to date. Therefore, we examined factors associated with LTFU, the effect of LTFU on proliferative diabetic retinopathy, and its interaction with different treatments.

Methods
A retrospective cohort study at a large safety net hospital examined 271 eyes of 271 patients with PDR that received PRP or IVI over a 2-year period. LTFU was defined as failure to return to care for at least 6 months. Baseline patient characteristics were collected. Ocular data was gathered at the visit before being LTFU, the return visit after being LTFU, and the final clinic visit. Univariate analyses and multivariate regression with adjustment for multiple comparisons to control confounders were conducted. 

Results
A history of LTFU was associated with subsequent neovascularization elsewhere (NVE) and tractional retinal detachment (TRD) but not with final visual acuity (VA). Among those LTFU, those who received IVI were not at higher risk of TRD than those receiving PRP.

Conclusion
Undergoing PRP is associated with LTFU. LTFU is independently associated with subsequent development of NVE and TRD, but not with the final visual acuity. One rationale in opting for PRP over IVI for managing PDR was the risk of the patient being LTFU, but our study did not demonstrate a difference between those who received PRP prior to LTFU and those who received IVI prior to LTFU in terms of the rate of subsequent TRD formation. Further studies should expand upon those findings to design better interventions strategies. 


Out of Sight, Not Out of Mind: The Effect of Loss to Follow-Up on on Proliferative Diabetic Retinopathy

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Out of Sight, Not Out of Mind: The Effect of Loss to Follow-Up on on Proliferative Diabetic Retinopathy

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