Children with amblyopia who are lost to follow-up after their initial visit appear to share some commonalities, including being older and non-white, in addition to lacking insurance, new research published in the American Journal of Ophthalmology reports.
Individuals were also more likely to be lost to follow-up if they had undergone previous amblyopia treatment, such as spectacle wear, patching or atropine, or had longer requested intervals between visits, the investigative team suggested.
The study reviewed medical records of approximately 2,000 patients treated for amblyopia at Boston Children’s Hospital from 2010 to 2014. A total of 324 kids (16%) between the ages of two and 12 failed to return after the first visit.
Considering follow-up times, a sub-analysis revealed a significant number of individuals didn’t return if their second visit was recommended between six and 12 months later. On the other hand, more children returned as scheduled when their follow-ups were six weeks or two months after the initial visit.
Overall, a lack of insurance was the most important predictor of patients lost to follow-up, followed by previous atropine and spectacle wear treatment, second visits scheduled at three months or longer and being older than six.
Older age as a risk factor may be due to the perceived lack of benefit of amblyopia treatment by both the provider and family, the authors said. “Nonetheless, this age group requires perhaps the strongest level of follow-up and treatment adherence in order to improve vision, especially in those who were not previously treated,” the researchers wrote in their paper.
While certain socioeconomic factors contributed to an increased risk, prescribed follow-up intervals of three months or longer was the only modifiable factor identified in the study, the researchers added.
An amblyopia risk score based on exam findings may help establish strategies and protocols at the time of diagnosis and enhance follow-up in patients at greatest risk, the researchers suggested.
Shoshany TN, Chinn RN, Staffa SJ, et al. Identifying characteristics predictive of lost-to-follow-up (LTFU) status in amblyopia. Am J Ophthalmol. May 13, 2021. [Epub ahead of print].