Continuity of care and risk of vision loss in patients with newly developed macular degeneration

Abstract

Purpose: Neovascular age-related macular degeneration (AMD) is a major cause of vision loss. Effective treatment requires sustained care, which may be influenced by continuity of care (COC). Understanding this association is crucial for improving patient outcomes. We investigated the association between COC and the risk of visual impairment in patients newly diagnosed with neovascular AMD.

Methods: This nationwide cohort study sourced data from the South Korean National Health Insurance Service database (2014-2021). In total, 15 563 (6210 females) newly diagnosed patients with neovascular AMD were included. The COC index, based on the frequency of ophthalmology visits over the first 2 years post-diagnosis, was assessed; a threshold of 0.75 was used to define good continuity. The primary outcome was visual impairment. Statistical models were used to assess the association between COC and the visual impairment risk, with adjustment for relevant confounding variables.

Results: Patients with a bad COC index had a significantly higher cumulative incidence (6.86% vs. 4.78%) and a higher incidence rate of visual impairment (909 vs. 704 cases per 100 000 person-years; 95% confidence interval, 764.0-1080.4, p < 0.001). This elevated risk was especially notable for female patients, patients aged ≥70 years, and patients with lower comorbidity burdens.

Conclusions: Poor COC is associated with increased visual impairment risk in patients with neovascular AMD. Strategies to improve COC may reduce this risk, particularly among older adults and high-risk groups.