For older people, one missed doctor’s visit may lead to vision loss

In a new study, researchers found that missing a single ophthalmology appointment over a two-year period was linked to decreased visual acuity for patients with macular degeneration—a leading cause of permanent vision loss in the elderly.

The findings suggest that more attention should be paid to ensuring visit adherence for this patient population.

The research was conducted by a team at Penn Medicine.

Age-related macular degeneration (AMD) happens when debris builds up in the central portion of the retina, called the macula, causing it to lose function, which leads to gradual wavy or blurred eyesight.

There are two types: dry, which is more common and less serious, and wet, which is less common but much more severe.

AMD is the leading cause of permanent vision loss in people over age 50, with an estimated 1.8 million Americans suffering and another 7.3 million at risk of developing the disease, according to the Centers for Disease Control and Prevention.

While there is no cure for wet AMD, vision can be maintained and often improved with anti-VEGF (intravitreal anti-vascular endothelial growth factor) drugs, which must be injected into the eye by an ophthalmologist.

However, this treatment comes with a big burden to the patient—mandating frequent, sometimes monthly, trips to the eye doctor.

In the study, the team analyzed data from the Comparison of Age-related Macular Degeneration Treatment Trial (CATT) randomized clinical trial.

The dataset included 1,178 patients recruited from 44 clinical centers in the United States.

During the two-year clinical trial, patients were required to visit, but not necessarily be treated with injections, by an ophthalmologist once every four weeks, totaling 26 visits.

The research team found patients who best adhered to their scheduled visits had better visual outcomes.

In fact, each missed visit was linked to an average visual acuity letter score decline of 0.7. Compared to those who attended all of their visits, those who averaged between 36 to 60 days between visits lost 6.1 letters, and those who went more than 60 days between visits lost 12.5 letters.

They also found that visit adherence was still associated with visual outcomes, independent of how many treatments someone received.

The study authors note that the findings are important, not only for improving patient outcomes but also due to impending changes in insurance reimbursement.

It has been reported that Medicare’s future goal will be to shift financial risks to the physician, while also accounting for patient outcomes.

A combination of social, financial, and educational barriers can prevent patients from attending scheduled doctor appointments.

The lead author of the study is Brian VanderBeek, MD, a professor of Ophthalmology at the University of Pennsylvania’s Perelman School of Medicine.

The study is published in JAMA Ophthalmology.

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