Insufficient Diabetic Retinopathy Follow-up Worsens Visual Outcomes

Clinicians must educate patients with diabetic retinopathy on the value of attending scheduled follow-up visits.

Failure to attend follow-up visits may result in worsening visual acuity outcomes and diabetic retinopathy (DR) grades among patients with DR, according to a retrospective analysis published in Clinical Ophthalmology.

Researchers included patients with diabetes who underwent DR screening between 2016 and 2021 who were discharged from their treatment center due to failure to adhere to follow-up visits (n=5900) or completion of treatment (n=9345). The team compared baseline characteristics, visual acuity, and DR grade between the 2 cohorts. 

According to the report, individuals discharged for missing follow-up were younger (60.7 vs 63.4 years), more likely to be men (67% vs 63%), more likely to have type 1 diabetes (27% vs 18%), and lived further from the treatment center (50.0 vs 42.2 km) compared with participants who were discharged due to completing treatment (P <.001 for all). Individuals who did not attend scheduled follow-up visits were also more likely to have a worsening DR grade (26% vs 8%) and worsening visual acuity in both eyes (P <.001 and P =.02 for the right and left eyes, respectively) compared with individuals who completed treatment. 

Non-attendance rate was highest for 2019 (29%) and lowest for 2018 (19%), the report shows.

Increased patient engagement is important to mitigate patient visual loss and progression of ophthalmic pathology.

“Our study has shown that there exists a subgroup of patients who are likely to be discharged from treatment centers for repeated non-attendance,” according to the study authors. “As a result, they are at risk of missing out on sight-saving treatments. Increased patient engagement is important to mitigate patient visual loss and progression of ophthalmic pathology.”

Study limitations include a lack of data pertaining to general health or motivating factors for non attendance. 

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


Harmon J, Kelly S, Acheson R, et al. The effect on patients’ visual acuity and grade, secondary to non-attendance at treatment centers, post referral from Diabetic RetinaScreen Ireland. Clin Ophthalmol. Published online January 11, 2023. doi:10.2147/OPTH.S388988