Identifying Who Is Most at Risk of Missing Follow-Up Care for Diabetic Eye Disease

A recent study conducted by researchers at Unity Health, Sunnybrook Health Sciences Center, and the University of Toronto has highlighted key sociodemographic factors associated with missed follow-up appointments among patients with diabetic eye conditions. The research reveals that males, Black, Hispanic, or residents living farther from treatment centers are significantly more likely to skip critical follow-up visits, which increases their risk of developing severe vision loss.

Published in JAMA Network Open, this study aims to inform strategies to improve patient retention in care and management of diabetic retinopathy, a leading cause of vision impairment among diabetic individuals. Diabetic retinopathy results from high blood sugar levels damaging the retina and affects roughly 1 in 4 Canadians with diabetes. If untreated, it can cause complications such as abnormal blood vessel growth and diabetic macular edema—both potentially leading to irreversible vision loss.

Effective treatments like laser therapy and anti-VEGF injections focus on halting blood vessel growth and reducing fluid leakage in the retina. However, successful management depends heavily on consistent follow-up. As Ryan Huang, a medical student at the University of Toronto and the study's first author, emphasizes, "Monitoring is absolutely necessary to preserve long-term vision."

The research team, under the mentorship of retinal specialist Marko Popovic, analyzed electronic medical records of 2,961 patients treated between 2012 and 2021. They defined 'lost to follow-up' as missing scheduled visits within a year of your last treatment. Results showed that 17% of patients were lost over the decade, with 41% never returning to care.

Findings indicated that men and Hispanic individuals had a 20 to 50% higher likelihood of missing follow-ups, while Black patients faced double the risk. Distance was also a key factor, with those living more than 20 kilometers from treatment centers being increasingly prone to gaps in care. Interestingly, patients with more severe disease, such as worse baseline vision or diabetic macular edema, were less likely to be lost—likely because they require more intensive treatment and are aware of the importance of ongoing care.

The study also discovered that patients receiving laser therapy were more prone to miss follow-up appointments compared to those receiving anti-VEGF injections. Huang notes that although laser treatments have longer-lasting effects, neglecting follow-up can lead to worsening vision. Restarting care can improve outcomes: laser-treated patients often regain their prior vision, whereas anti-VEGF patients may not recover fully after a lapse.

To prevent patients from dropping out of care, the researchers suggest proactive measures such as automated appointment reminders, culturally and linguistically tailored education resources, and coordinated transportation services—all aimed at making follow-up more accessible.

Ultimately, these findings have broad implications beyond ophthalmology, highlighting the importance of regular follow-up in managing chronic diseases. Implementing these strategies could significantly reduce preventable vision loss caused by diabetic retinopathy.

Source: https://medicalxpress.com/news/2025-08-critical-diabetic-eye-disease.html