Adherence to follow-up after point-of-care diabetic retinopathy examination was associated with patient factors (age, marital status), clinical factors (AMD findings on DRE, prior eye disease), and system factors (no-show rates, patient contact within 30 days), supporting targeted, multifactorial interventions.
Only about one-third of examinations with recommended follow-up were followed by an eye care visit within 180 days.
Increasing age was associated with higher odds of loss to follow-up in the full cohort.
Not being married was associated with higher odds of loss to follow-up.
Findings suggestive of age-related macular degeneration (AMD) on the DRE were associated with higher odds of loss to follow-up.
Higher clinic/patient no-show rates were associated with higher odds of loss to follow-up, and this was the only factor that remained significant in the indeterminate (ungradable/no image) model.
A history of eye disease was associated with lower odds of loss to follow-up.
Patient contact within 30 days of the exam was associated with lower odds of loss to follow-up, while contact at 31-60 days was not significantly associated.
Socioeconomic variables, comorbidities, and diabetic retinopathy severity were not independently associated with loss to follow-up after adjustment.
This study looked at people with diabetes who had a quick eye screening for diabetic retinopathy during a visit to their primary care clinic in Pennsylvania. Among 3,121 screenings where a follow-up eye visit was recommended, only about one in three (32.3%) were followed by an eye care visit within six months. People who were older, not married, or who had screening findings suggestive of age-related macular degeneration were more likely to miss follow-up. Patients with a higher rate of missed appointments were also more likely to be lost to follow-up. In contrast, people with a history of eye disease, and those who were contacted within 30 days of the screening (especially the same or next day), were more likely to attend. Income-related measures, other health conditions, and how severe the retinopathy was did not independently predict missed follow-up. This research suggests that no single factor explains why people miss follow-up eye care, and that prompt outreach after screening may matter. The findings support using several targeted approaches, such as early contact and extra support for patients with a history of missed appointments. The study was retrospective, so it shows associations rather than proving cause and effect.
Bonilla-Escobar F, Atta S, Eibel M, Wesalo J, Chang J, Sánchez-Cano D, et al.. (2026). Factors associated with loss to follow-up after point-of-care diabetic retinopathy examination in a teleophthalmology program: A retrospective cohort study.. PloS one. https://doi.org/10.1371/journal.pone.0359305