Follow-Up Adherence and Barriers to Care for Pediatric Glaucomas at a Tertiary Care Center

PURPOSE: To determine the percent adherence to follow-up for patients with pediatric glaucomas seen at a tertiary care center and to elucidate risk factors.

DESIGN: Retrospective cohort study METHODS: Patients with pediatric glaucomas seen at the University of Minnesota over 8.5 years were classified as adherent (A), nonadherent (NA), or lost to tertiary follow-up (LTTF) if they followed up within 0-30 days, between 31-180 days, or later than 180 days of the recommended appointment time or never, respectively.

RESULTS: Of 176 patients analyzed, 95 (54%) were A (51% male; mean [standard deviation (SD)] age: 56.1 [59.8] months), 5 (3%) were NA (20% male; mean [SD] age: 25.0 [35.8] months), and 76 (43%) were LTTF (55% male; mean [SD] age: 58.9 [53.1] months). Multiple logistic regression analysis of variables that were significant in isolation revealed that only race (white: odds ratio [OR], 3.58; 95% CI, 1.42-9.05; p = 0.007) and distance from eye clinic (per 50 miles: OR, 0.79; 95% CI, 0.67-0.92; p = 0.003) significantly impacted adherence.

CONCLUSIONS: This is the first study of adherence to follow-up recommendations for patients with pediatric glaucomas. Percent adherence to follow-up appointments was alarmingly low, and decreased adherence was observed with non-white race and increased distance to the eye clinic. Physicians should consider these risk factors when risk-stratifying pediatric glaucoma patients for nonadherence to follow-up. Additional studies to improve adherence through interventions that reduce biases and barriers to follow-up are needed.