The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes

Precis: This study addresses the paucity of literature examining glaucoma patients' distance from clinic on postoperative follow-up outcomes. Greater distance from clinic was associated with higher likelihood of loss to follow-up and missed appointments. Purpose: To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance. Methods and Participants: Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill's Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson chi(2), analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up. Results: In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24-4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t((150))=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t((197))=3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t((144))=-2.193; P<0.05). Conclusions: Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.