Factors Affecting Compliance to Anti-Vascular Endothelial Growth Factor Treatment of Diabetic Macular Edema in a Cohort of Jordanian Patients

Figures & data

Table 1 Characteristics of Patients Included in This Study

		Mean	Standard Deviation	Count	Column N %
Age		62.93	9.75
Sex	Male			65	55.6%
	Female			52	44.4%
Laterality	Right			3	2.6%
	Left			5	4.3%
	Both			109	92.3%
Insurance (types)	Ministry of health			82	70.1%
	Medical exemption			27	23.1%
	Official universities			6	5.1%
	Military insurance			1	0.9%
	Private			1	0.9%
Level of education	Higher education			38	32.5%
	Basic education			79	67.5%
Level of education (stages)	No education			13	11.1%
	Elementary school			48	41.0%
	High school			18	15.4%
	Undergraduate			30	25.6%
	Postgraduate			8	6.8%
Mode of travel	Private transportation			55	47.0%
	Public transportation			62	53.0%
Employment status (during disease management)	Employed			19	16.2%
	Not employed			98	83.8%
Place of residence	Inside Amman			25	21.4%
	Amman suburbs			42	35.9%
	Outside Amman			50	42.7%
Marital Status	Single			22	18.8%
	Married			87	74.4%
	Divorced			6	5.1%
	Widowed			2	1.7%
DME awareness level	Aware they have DME			99	84.6%
	Limited awareness (not sure what DME is)			18	15.4%
VA baseline		0.30	0.23
	<0.5			87	74.4%
	≥0.5			30	25.6%
Onset of symptoms until diagnosis		13.94	30.34
	Early (less than 3 months)			73	62.4%
	Late (3 months or more)			44	37.6%
Mobility	Patient wheel chair bound			26	22.2%
	Not Impaired			91	77.8%
Co-morbid systemic diseases	DM			117	100.0%
	HTN			85	72.6%
	IHD			38	32.5%
	Kidney disease			12	10.3%
	2 Diseases			45	38.5%
	3 or more diseases			50	42.7%
OCT done and explained to patient by physician	Done			110	94.0%
	Not done			1	0.9%
	Do not know			6	5.1%
Perception of the duration of the injection procedure		60.79	65.40
	Quick (in and out in less than 1 hr)			90	76.9%
	Long (more than 1 hr)			27	23.1%
Perception of duration of the follow up visit		97.28	66.70
	Quick (in and out in less than 1 hr)			59	50.4%
	Long (more than one hour)			58	49.6%
Same session bilateral	Yes			26	22.2%
	No			91	77.8%
Number of companions during visit		1.14	0.472
	0			4	3.4%
	1			95	81.2%
	2			16	13.7%
	3			2	1.7%
Perceived complications	Positive			21	17.9%
Complications (types)	Bleeding in the eye			6	5.1%
	Increased IOP			1	0.9%
	Floaters			5	4.3%
	Swelling or redness or itching			6	5.1%
	Immediate drop of vision			2	1.7%
	Diplopia			1	0.9%
Objective compliance (per criteria)	Compliant			85	72.6%
Reasons for noncompliance	Financial			14	12.0%
	Social			2	1.7%
	Not satisfied with Patient care			7	6.0%
	Poor knowledge about disease			3	2.6%
Objective VA improvement	Improved 2 Snellen lines after 3 loading doses			36	30.8%
	Not improved			81	69.2%
Subjective VA improvement	Improved (patient asserts their vision is better after 3 loading doses)			59	50.4%
	Not improved			58	49.6%

Notes: A chi-square test of independence was performed to examine the relationship between objective compliance and other factors, and between subjective compliance and the same factors. Detailed results are presented in (Table 2).

Abbreviations: VA, Visual acuity; DME, Diabetic macular edema; DM, Diabetes mellitus; HTN, Hypertension; IHD, Ischemic heart disease.OCT, Optical coherence tomography; IOP, Intraocular pressure.

Table 2 Relation Between Compliance and Other Factors

Factor	Compliance	Pearson Chi-Square	df	Asymptotic Significance (2-Sided)
Same session bilateral	Objective	0.888	1	0.346
	Subjective	1.413	1	0.235
Sex	Objective	0.551	1	0.458
	Subjective	1.197	1	0.274
Insurance (types)	Objective	3.989	4	0.408
	Subjective	5.098	4	0.277
Insurance (yes or no)	Objective	0.632	1	0.427
	Subjective	1.114	1	0.291
Education Level	Objective	1.913	4	0.752
	Subjective	1.635	4	0.802
Level of education (high vs low)	Objective	0.381	1	0.537
	Subjective	0.045	1	0.833
Employment status	Objective	0.453	1	0.501
	Subjective	0.018		0.893
Mode of travel	Objective	0.000	1	0.986
	Subjective	0.120	1	0.729
Mobility impaired (Type)	Objective	0.164	2	0.921
	Subjective	3.285	2	0.193
HTN	Objective	0.337	1	0.562
	Subjective	0.003	1	0.956
IHD	Objective	0.381	1	0.537
	Subjective	1.347	1	0.246
Kidney disease	Objective	0.037	1	0.847
	Subjective	0.239	1	0.625
	Subjective	0.901	1	0.343
Disease laterality	Objective	2.828	2	0.243
	Subjective	4.527	2	0.104
VA at first visit	Objective	1.097	1	0.295
	Subjective	0.115	1	0.734
Symptoms duration (until diagnosis) early vs late	Objective	0.171	1	0.679
	Subjective	0.127	1	0.721
OCT performed	Objective	3.001	2	0.223
	Subjective	3.618	2	0.164
Complications types	Objective	6.584	6	0.361
	Subjective	5.577	6	0.472
Complications (with vs without)	Objective	0.161	1	0.688
	Subjective	0.149	1	0.699
Compliance subjective	Objective	70.987	1	0.000
	Subjective	70.987	1	0.000
Reasons for noncompliance	Objective	10.371	3	0.016
	Subjective	0.851	3	0.837
DME awareness level	Objective	1.222	1	0.269
	Subjective	1.519	1	0.218
Objective VA gain	Objective	0.688	1	0.407
	Subjective	0.232	2	0.630
Subjective VA gain	Objective	4.540	1	0.033
	Subjective	0.244	1	0.621

Notes: Only one independent variable made a unique statistically significant contribution: the relationship between subjective VA improvement (as perceived by the patient after receiving three loading doses) and objective compliance (as set by aforementioned criteria) was statistically significant, X2 (1, N = 117) = 4.540, p =0.033, V =0.197.

Abbreviations: VA, Visual acuity; DME, Diabetic macular edema; DM, Diabetes mellitus; HTN, Hypertension; IHD, Ischemic heart disease; OCT, Optical coherence tomography; IOP, Intraocular pressure; Df, degrees of freedom.