Patients With Proliferative Diabetic Retinopathy Experience Long Lapses in Care

Retina of diabetic - diabetic retinophaty
Retina of diabetic – diabetic retinophaty
The likelihood of lapses in care should be considered when selecting treatment for proliferative diabetic retinopathy, researchers say.

In 5 years of follow-up, approximately half of the participants undergoing ranibizumab treatment for proliferative diabetic retinopathy (PDR) had a long lapse in care, according to study findings published in JAMA Ophthalmology.

Researchers conducted a post hoc analysis to characterize the frequency and pattern of lapses in follow-up among these patients. The analysis was performed at 55 United States sites among 305 adults with PDR included between February and December 2012. The participants completed the final 2 year visit in January 2015.

Among the 191 participants with an eye assigned to ranibizumab, 21 died throughout the follow-up period, investigators report. Of the remaining 170 participants, the median age was 51 years and 44.7% were women. 

Throughout 5 years of follow-up, 94 participants (55.3%) experienced 1 or more long lapse in care, according to the report. The median time to the first long lapse was 210 weeks, and after the first long lapse, 69 of 94 participants (73.4%) returned for examination. By 5 years, 50 of 170 participants (29.4%) discontinued follow-up. 

Regarding the 120 participants who completed the 5-year examination, median change from baseline in visual acuity was -2 letters for participants who had 1 or more long lapse vs +5 letters for participants without a long lapse (P =.02). 

Following multivariable adjustment, the odds ratio (95% CI) for baseline associations with 1 or more long lapse was 1.21 (1.03-1.43) for each 5-letter reduction in visual acuity score, 2.19 (1.09-4.38) for neovascularization of the disc and elsewhere, and 3.48 (1.38-8.78) for no previous history of laser treatment for diabetic macular edema.

The study notes several limitations. Researchers could not determine if the 29% of participants who dropped out returned to care elsewhere. Additionally, the ability of baseline factors to predict who will experience a long lapse was limited. 

“The likelihood of a long lapse in care during long-term follow-up needs to be considered when choosing treatment for PDR,” according to the researchers. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. This research was supported by multiple sources. Please see the original reference for a full list of authors’ disclosures.


Maguire MG, Liu D, Bressler SB, et al. Lapses in care among patients assigned to ranibizumab for proliferative diabetic retinopathy. JAMA Ophthalmol. Published online October 21, 2021. doi:10.1001/jamaophthalmol.2021.4103