The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes.

Ian T Funk,Eric Van Buren,Feng-Chang Lin,O’Rese J Knight,David Fleischman,Bryan A Strelow,Meredith R Klifto

doi:10.1097/ijg.0000000000001609

Abstract

To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance. Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill's Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson χ, analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up. In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24-4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t(150)=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t(197)=3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t(144)=-2.193; P<0.05). Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.

Highlights

The current standard of treatment of glaucoma is the reduction of intraocular pressure (IOP) through topical medications, laser, and surgery to maintain quality of life and reduce vision loss
199 patients met all inclusion criteria. 6-months postoperatively, patients > 50 miles from clinic had greater odds of loss to follow-up compared to patients < 25 miles
Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up

Summary

Introduction

The current standard of treatment of glaucoma is the reduction of intraocular pressure (IOP) through topical medications, laser, and surgery to maintain quality of life and reduce vision loss. Surgical interventions such as trabeculectomy and tube shunt implantations require frequent follow-up and monitoring to assess their function, evolution, and possible complications.[1,2,3,4] The American Academy of Ophthalmology’s (AAO) Preferred Practice Pattern Guideline attributes long-term surgical success to follow-up retention, but lack recommendations considering the follow-up demands for each procedure and the adverse outcome risks for patients who may be more susceptible for loss to follow-up due to increased travel distance.[2]. Additional appointments are scheduled at the surgeon’s discretion until expected surgical outcomes have been met.[3,5,6,7] Trabeculectomy, as compared to other glaucoma procedures, typically has more follow-up care and the possible need for medical or procedural intervention or surgical revision.[8,9]

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