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Abstract

Introduction: Diabetic macular oedema (DMO) is a major cause of visual loss in the diabetic population. There are several treatment options for DMO, including intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, which have been shown to improve visual outcomes. Good compliance to treatment regimens is associated with greater visual benefit.

Purpose: To estimate dropout rates and the associated reasons among DMO patients on three different anti-VEGF treatments.

Study design: A retrospective review of patients with DMO who were on bevacizumab, ranibizumab and aflibercept therapy from January 2014 to December 2016.

Materials and methods: Patients with DMO on anti-VEGF treatment in a private ophthalmology center were identified via an electronic database. Data on Malaysian residents aged 18 years or older were included. Foreign residents, the deceased, and those whose care had been transferred to another center were excluded from further analysis. Telephone interviews were then conducted with these patients based on a standard questionnaire to identify reasons for non-compliance.

Results: This study included 134 patients. The overall lost to follow-up rate was 56.0% (75/134). After excluding the deceased, those who opted for treatment at an alternative center, and uncontactable patients, 47 (35.1%) were then identified as drop-outs. Financial constraint was the most common reason cited by 38.3% patients (18/47) and was highest in the bevacizumab group (88.9%, 16/18). The second most common reason was lack of perceivable change in vision (25.5%). In addition, 19.1% opted to stop treatment due to logistical difficulties and 12.8% of patients were satisfied with their stable visual acuity. Lastly, 4.3% were unable to continue with treatment due to poor general health.

Conclusion: The dropout rate of 35.1% is higher than in previous publications from other countries. This study clarifies the challenges face by some Malaysian patients in seeking treatment for what is often a chronic disease. These results have implications on designing ways to assist patients’ cooperation with the standard of care.