Missing A Single Appointment Can Lead To Vision Loss For Aging Patients

For those with aging parents, vision loss can be an added concern. Regular exams are important to keep health on track, and a new study shows that missing just one ophthalmology appointment over a two-year period can lead to vision loss.

Findings published today in JAMA Ophthalmology showed that over a two-year period, missing a single appointment was associated with decreased visual acuity for patients with macular degeneration.

Age-related macular degeneration (AMD) is the leading cause of severe, permanent vision loss in people over the age of 60. It occurs when the small central portion of the retina called the macula wears down. The retina is the light-sensing nerve tissue at the back of the eye. It can lead to loss of function, which leads to gradual wavy or blurred eyesight.

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

There are two types of AMD. Dry, which is more common and less serious than wet, a less common but much more severe type of AMD. There is no cure for wet AMD, but it can be well maintained and often improved with anti-VEGF (intravitreal anti-vascular endothelial growth factor) drugs. However, these drugs must be injected into the eye by an ophthalmologist, which can be a burden to the patient, requiring frequent trips to the eye doctor.

Doctor Visits Are Critical

Brian VanderBeek, MD, a professor of Ophthalmology at the University of Pennsylvania’s Perelman School of Medicine said, “Research of other diseases has shown the importance of appointment adherence. In patients with HIV, for example, studies have found that showing up to appointments has been linked to lower mortality rates and reduced viral loads. But unlike HIV patients, who can have prescriptions filled over the phone by any physician, anti-VEGF therapy can only be administered by an ophthalmologist, making visit adherence even more critical for those with macular degeneration. I wanted to quantify the link between regular visits to the eye doctor and visual outcomes for these patients.”

For the study, Vanderbeek and his team analyzed data from the Comparison of Age-related Macular Degeneration Treatment Trial (CATT) randomized clinical trial. It included 1,178 patients recruited from 44 clinical centers in the United States. During the two-year trial, patients were required to visit an ophthalmologist once every four weeks, totaling 26 visits.

Patients were assessed on their total number of missed visits, average number of days between visits, longest duration between visits, and visit constancy (the total of three-month periods with at least one visit attended). Those metrics were then compared to the patients’ outcomes on their final vision tests.

It was found that patients who best adhered to their scheduled visits had better visual outcomes. Each visit was shown to be associated with an average visual acuity letter score decline of 0.7 Compared to those who attended all of the 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.

Ophthalmologists have long been having discussions regarding the number of anti-VEGF injections that are appropriate to give a patient. “It’s important to reframe how we think about this. Let’s worry less about predicting a specific number of injections a patient needs and more about getting them into the doctor’s office,” VanderBeek said.

The findings are important, for those with aging parents to ensure they get to each appointment as it is vital for improving patient outcomes and preventing vision loss.