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Bradford W. Lee, MSc; Parthasarathi Sathyan, DO, DNB; Rajesh K. John, MS; Kuldev Singh, MD, MPH; Alan L. Robin, MD

Arch Ophthalmol. 2008;126(10):1448-1454.

Objectives  To determine predictors of and reasons for poor longitudinal glaucoma follow-up in South India.

Methods  This 1-to-1, matched, case-control study enrolled 300 patients with established glaucoma. We defined cases (poor follow-up) and controls (good follow-up) based on number of and maximum interval between glaucoma follow-up visits attended in the preceding year. We collected data by oral questionnaire and used stepwise multivariate logistic regression to calculate odds ratios (ORs) for poor follow-up.

Results  Adjusting for age and sex, independent predictors of poor follow-up included lack of formal education (adjusted OR, 4.13; 95% confidence interval [CI], 1.44-11.90), no use of prescribed glaucoma medications (adjusted OR, 2.17; 95% CI, 1.06-4.43), and belief that follow-up is less important if one uses glaucoma medications and has no noticeable visual changes (adjusted OR, 10.59; 95% CI, 3.74-29.97). Age, sex, and disease severity were not significant predictors. The most prevalent barriers to follow-up were belief that there was no problem with one's eyes (44.4%) and lack of escort (19.7%).

Conclusions  Knowing predictors of poor follow-up can help identify patients who need individualized strategies to improve follow-up. Because believing one's eyes are problem-free and lacking escorts are significant barriers to follow-up, novel strategies in patient education (eg, intensive counseling, audiovisual aides, and patient support groups) and escort provision may improve longitudinal glaucoma follow-up and disease management.

Author Affiliations: Stanford University, Stanford, California (Mr Lee and Dr Singh); Aravind Eye Care System, Coimbatore, India (Dr Sathyan); Delve Data Systems, Coimbatore, India (Mr John); and Johns Hopkins University, Baltimore, Maryland (Dr Robin).