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Peer-reviewedCC BYPLOS One

Factors associated with loss to follow-up after point-of-care diabetic retinopathy examination in a teleophthalmology program: A retrospective cohort study

  • Francisco J Bonilla-Escobar1,2,3
  • Sarah Atta1
  • Maria R Eibel1
  • Joshua S Wesalo1
  • Jordan T Chang1
  • Daniel Sánchez-Cano3
  • Andrew Eller1
  • Evan L Waxman1
  1. 1Department of Ophthalmology, University of Pittsburgh, UPMC Vision Institute, Pittsburgh, Pennsylvania, United States of America.
  2. 2Department of Ophthalmology, Grupo de Investigación Visión y Salud Ocular (VISOC), Servicio de Oftalmología, Universidad del Valle, Hospital Universitario del Valle, Evaristo Garcia E.S.E., Cali, Colombia.
  3. 3Fundación Somos Ciencia al Servicio de la Comunidad, Fundación SCISCO / Science to Serve the Community Foundation, SCISCO Foundation, Cali, Valle del Cauca, Colombia.
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Abstract

Objective: To identify patient-, clinical-, and system-level factors associated with loss to follow-up after point-of-care diabetic retinopathy examination (DRE). Methods: We conducted a retrospective cohort study of adults ≥18 years undergoing DREs at 75 primary care clinics in Pennsylvania, USA (2017–2019), restricted to examinations with recommended follow-up. The unit of analysis was the DRE. Electronic medical records were used to obtain six-month follow‑up outcomes and patient-, clinical-, and system-level variables. Loss to follow-up was defined as failure to attend an eye care visit within 180 days of DRE. Examinations with duplicate results, those from patients who died within six months, or from sites where the program was discontinued were excluded. Multivariable mixed-effects logistic regression models with random intercepts for patient and clinic were used. Analyses were conducted in the full cohort and separately for gradable and indeterminate exams (ungradable/no image). Results: Among 3,121 DREs from 2,959 patients, 32.3% completed follow-up. In the full cohort, higher odds of loss to follow-up were associated with increasing age (adjusted odds ratio [aOR]=1.02, 95% confidence interval [95%CI]=1.00–1.03, p = 0.019), not being married (aOR=1.36, 95%CI = 1.04–1.77, p = 0.03), findings suggestive of age-related macular degeneration (AMD) on DRE (aOR=1.80, 95%CI = 1.14–2.85, p = 0.012), and higher no-show rates (aOR=1.04, 95%CI = 1.02–1.05, p < 0.0001). History of eye disease (aOR=0.50, 95%CI = 0.37–0.69, p < 0.0001) and patient contact within 30 days (e.g., same/next day: aOR=0.37, 95%CI = 0.20–0.67, p = 0.001) were associated with lower odds of loss to follow-up; contact at 31-60 days was not significantly associated. Findings were consistent across full and gradable models; only no-show rate remained significant in the indeterminate model. Socioeconomic variables, comorbidities, and diabetic retinopathy severity were not independently associated with loss to follow-up after adjustment. Conclusions: Adherence was associated with patient (sociodemographic: age, marital status), clinical (AMD on DRE, prior eye disease), and system-level factors (no-show rates, patient contact within 30 days), supporting targeted, multifactorial interventions.

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Cite

BibTeXRIS
BibTeX
@article{bonillaescobar2026factors,
  title = {{Factors associated with loss to follow-up after point-of-care diabetic retinopathy examination in a teleophthalmology program: A retrospective cohort study}},
  author = {Francisco J Bonilla-Escobar and Sarah Atta and Maria R Eibel and Joshua S Wesalo and Jordan T Chang and Daniel Sánchez-Cano and Andrew Eller and Evan L Waxman},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0359305},
  url = {https://doi.org/10.1371/journal.pone.0359305},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Factors associated with loss to follow-up after point-of-care diabetic retinopathy examination in a teleophthalmology program: A retrospective cohort study
AU  - Francisco J Bonilla-Escobar
AU  - Sarah Atta
AU  - Maria R Eibel
AU  - Joshua S Wesalo
AU  - Jordan T Chang
AU  - Daniel Sánchez-Cano
AU  - Andrew Eller
AU  - Evan L Waxman
PY  - 2026
DA  - 2026/10/29
JO  - PLOS One
DO  - 10.1371/journal.pone.0359305
UR  - https://doi.org/10.1371/journal.pone.0359305
AB  - Objective: To identify patient-, clinical-, and system-level factors associated with loss to follow-up after point-of-care diabetic retinopathy examination (DRE). Methods: We conducted a retrospective cohort study of adults ≥18 years undergoing DREs at 75 primary care clinics in Pennsylvania, USA (2017–2019), restricted to examinations with recommended follow-up. The unit of analysis was the DRE. Electronic medical records were used to obtain six-month follow‑up outcomes and patient-, clinical-, and system-level variables. Loss to follow-up was defined as failure to attend an eye care visit within 180 days of DRE. Examinations with duplicate results, those from patients who died within six months, or from sites where the program was discontinued were excluded. Multivariable mixed-effects logistic regression models with random intercepts for patient and clinic were used. Analyses were conducted in the full cohort and separately for gradable and indeterminate exams (ungradable/no image). Results: Among 3,121 DREs from 2,959 patients, 32.3% completed follow-up. In the full cohort, higher odds of loss to follow-up were associated with increasing age (adjusted odds ratio [aOR]=1.02, 95% confidence interval [95%CI]=1.00–1.03, p = 0.019), not being married (aOR=1.36, 95%CI = 1.04–1.77, p = 0.03), findings suggestive of age-related macular degeneration (AMD) on DRE (aOR=1.80, 95%CI = 1.14–2.85, p = 0.012), and higher no-show rates (aOR=1.04, 95%CI = 1.02–1.05, p < 0.0001). History of eye disease (aOR=0.50, 95%CI = 0.37–0.69, p < 0.0001) and patient contact within 30 days (e.g., same/next day: aOR=0.37, 95%CI = 0.20–0.67, p = 0.001) were associated with lower odds of loss to follow-up; contact at 31-60 days was not significantly associated. Findings were consistent across full and gradable models; only no-show rate remained significant in the indeterminate model. Socioeconomic variables, comorbidities, and diabetic retinopathy severity were not independently associated with loss to follow-up after adjustment. Conclusions: Adherence was associated with patient (sociodemographic: age, marital status), clinical (AMD on DRE, prior eye disease), and system-level factors (no-show rates, patient contact within 30 days), supporting targeted, multifactorial interventions.
SN  - 1932-6203
ER  -