Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients

Figures & data

Figure 1 Follow-up over 12 months in nAMD, DME, and BRVO patients.

Notes: Success, no treatment or follow-up necessary, leading to intended gap >56 days; continuous adherence, patient underwent frequent treatments or follow-ups at least every 56 days; nonadherence, at least one unintended gap >56 days between treatments or follow-ups; this subgroup is further analyzed in Figure 2.
Abbreviations: nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion.

Figure 2 Reasons for unintended treatment gaps (NA).

Notes: Patient, patient-associated NA; center, center-associated NA; inactive, no treatment necessary at last visit before NA; active, treatment intended at last visit before NA.
Abbreviations: nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion; NA, nonadherence.

Figure 3 Kaplan–Meier estimation of incidence of NA over the course of 365 days.

Note: p=0.014 between groups, log-rank test.
Abbreviations: NA, nonadherence; nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion.

Table 1 Regression analysis for risk factors for patient-associated NA

Variable	nAMD		DME		BRVO
	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Intercept	0.01 (0.00; 0.13)	<0.001	1.79 (0.10; 30.8)	0.689	0.26 (0.00; 34.0)	0.588
Age (years)	1.04 (1.01; 1.06)	0.013	0.99 (0.96; 1.03)	0.757	1.00 (0.94; 1.05)	0.876
Sex (female)	0.74 (0.48; 1.16)	0.189	0.57 (0.25; 1.31)	0.185	1.59 (0.51; 4.97)	0.426
Mobility impaired	0.98 (0.48; 2.00)	0.961	1.27 (0.34; 4.79)	0.720	0.63 (0.07; 6.00)	0.686
Upload successful	1.07 (0.41; 2.82)	0.892	0.30 (0.08; 1.23)	0.094	0.72 (0.06; 9.25)	0.801
VA study eye >0.1–0.3 logMARa	2.42 (0.90; 6.49)	0.079	1.37 (0.40; 4.75)	0.617	0.38 (0.02; 7.50)	0.525
VA study eye >0.3 logMARa	2.37 (1.01; 5.57)	0.048	1.75 (0.54; 5.73)	0.352	2.0 (0.21; 19.3)	0.550
Study eye better than fellow eye	0.93 (0.60; 1.46)	0.765	1.58 (0.71; 3.51)	0.259	0.46 (0.14; 1.57)	0.214
Both eyes treated	1.23 (0.67; 2.26)	0.503	0.52 (0.20; 1.36)	0.185	<0.00 (0; inf)	0.993

Notes:

a Compared with VA study eye <0.1 logMAR. Statistically significant p-values (<0.05) are shown in bold.

Abbreviations: NA, nonadherence; nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion; OR, odds ratio; CI, confidence interval; VA, visual acuity.

Figure 4 Development of visual acuity after 12 months for nAMD, DME, and BRVO, stratified for follow-up (adherent/nonadherent).

Note: *p<0.05.
Abbreviations: nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion.

Table 2 Description of study groups with patient and treatment characteristics, stratified for adherence

Follow-up	nAMD			DME			BRVO
	Adherent	Nonadherent	p-value	Adherent	Nonadherent	p-value	Adherent	Nonadherent	p-value
Patients, No (%)	316 (68)	150 (32)		75 (56)	59 (44)		81 (75)	27 (25)
Age, mean (SD), years	77.9 (7.8)	79.0 (8.8)	0.1784	65.7 (11.4)	66.6 (10.2)	0.6602	69.3 (10.3)	69.1 (13.4)	0.8175
Female, No (%)	206 (65)	88 (59)	0.1827	30 (40)	17 (29)	0.5759	41 (51)	14 (52)	1.000
Impaired mobility, No (%)	28 (8.9)	15 (10.0)	0.7327	6 (8.0)	5 (8.5)	1.000	4 (4.9)	3 (11.1)	0.3632
VA study eye baseline	0.514 (0.371)	0.515 (0.335)	0.7699	0.384 (0.266)	0.405 (0.288)	0.6816	0.459 (0.315)	0.581 (0.332)	0.06059
VA study eye 1 year	0.507 (0.423)	0.534 (0.407)	0.3006	0.309 (0.249)	0.391 (0.293)	0.0866	0.276 (0.355)	0.371 (0.391)	0.1166
Change of VA study eye	−0.008 (0.338)	+0.019 (0.299)	0.1816	−0.076 (0.213)	−0.014 (0.267)	0.2005	−0.183 (0.348)	−0.209 (0.338)	0.7014
VA fellow eye baseline	0.569 (0.650)	0.566 (0.661)	0.8728	0.314 (0.364)	0.380 (0.359)	0.08158	0.062 (0.134)	0.175 (0.409)	0.2999
Both eyes treated, No (%)	44 (13.9)	19 (12.7)	0.7731	20 (26.7)	11 (18.6)	0.3079	2 (2.5)	0 (0)	1.000
Upload successful, No (%)	307 (97.2)	139 (92.7)	0.04683	71 (94.7)	53 (89.8)	0.3348	79 (97.5)	26 (96.3)	1.000
VA study eye better than fellow eye	155 (49.1)	71 (47.3)	0.7664	41 (54.7)	34 (57.6)	0.861	31 (38.3)	7 (25.9)	0.352
Days diagnosis to IVI, mean (SD)	20.8 (11.6)	19.3 (13.1)	0.2626	24.5 (13.1)	21.2 (14.9)	0.1953	18.4 (11.1)	16.2 (10.7)	0.3286
OCT, No (SD)	4.2 (1.9)	2.9 (1.9)	<0.0001	4.1 (2.1)	2.2 (1.8)	<0.0001	3.8 (1.8)	3.2 (1.8)	0.1592
IVI, No (SD)	6.8 (2.6)	5.0 (2.3)	<0.0001	7.4 (2.4)	5.1 (2.5)	<0.0001	6.0 (2.8)	5.1 (2.2)	0.09834
OCT + IVI, No (SD)	11.1 (2.9)	7.9 (3.2)	<0.0001	11.5 (3.0)	7.3 (3.8)	<0.0001	9.8 (3.5)	8.3 (3.1)	0.01828

Notes: VA displayed as mean (SD), logMAR. Statistically significant p-values (<0.05) are shown in bold.

Abbreviations: nAMD, neovascular age-related macular degeneration; DME, diabetic macular edema; BRVO, branch retinal vein occlusion; VA, visual acuity; No, number; SD, standard deviation; IVI, intravitreal injection; OCT, optical coherence tomography.