Narayanan, Raja

Purpose: To determine the factors associated with compliance with recommended intravitreal injections (IVIs) for retinal diseases among out-of-pocket, insured, and fully subsidized (non-paying) patients. Methods: This retrospective observational hospital-based study included patients recommended for IVI in at least one eye between November 2011 and May 2022. Three cohorts of patients were assessed: out-of-pocket payers, insured, and those fully subsidized (non-paying) by the hospital. The main outcome measure was the compliance rate, defined as the proportion of patients receiving an injection after one was recommended. The impact on the visual outcome in each cohort was a secondary outcome. Results: Overall, 50,408 IVI were recommended for at least one eye and were included in the analyses. Male patients were more common (66.72%), and the mean age was 55.36 ± 16.39 years. The overall compliance rate with the first recommended injection was 51.37%, which increased and eventually stabilized with subsequent recommendations to approximately 80% (range: 77.48%–82.93%). Insured patients had a higher compliance rate with the first recommendation compared to the non-insured (100% vs. 49.84%; P < 0.000 01 ), and non-paying patients had a higher compliance rate after the first recommendation compared to paying patients (62.51% vs. 48.66%; P < 0.000 01 ). Patients with insurance achieved a better visual outcome at the last follow-up compared to other cohorts. Conclusion: Insured patients have a much higher compliance rate with recommended IVIs compared to out-of-pocket or non-paying patients. The high non-compliance rate among non-paying patients suggests that factors other than the direct cost of the injections may impact compliance with recommended treatment.

Purpose: To describe the characteristics and outcomes of eyes with idiopathic full-thickness macular holes that underwent initial medical management. Methods: This retrospective study included eyes with full-thickness macular holes that were initially managed with 1 month of topical therapy. Eligible subjects were treated with dorzolamide 2% three times a day, nepafenac 0.1% twice a day, and prednisolone acetate 1% four times a day. The primary end points was hole closure at one month and secondary end point was change in best-corrected visual acuity. Results: Ten subjects (mean age: 62.80 years; female: 50%) with unilateral full-thickness macular holes were studied. The mean basal diameter of the entire cohort at baseline was 824.1 µm (median 828 µm). Four (40%) of the smaller holes (mean 698 µm; median 698.50 µm) closed after 1 month of topical therapy, whereas larger holes (mean 908.17 µm; median 889.50 µm) did not close. In one eye, the hole reopened 4 months after stopping the medication but closed again at 1 month after restarting the topical treatment. Median best-corrected visual acuity improved from 0.35 logMAR at baseline to 0.05 logMAR in eyes that closed but remained at 0.70 logMAR at 1 month in eyes that did not close. Conclusion: Topical corticosteroid, nonsteroidal antiinflammatory, and carbonic anhydrase inhibitor therapy may promote closure of small full-thickness macular holes, but large holes are less likely to respond. One month of topical therapy might avoid subjecting some patients to complex vitreoretinal surgery without compromising visual outcomes. Macular hole may reopen after stopping the topical therapy.