Longer Follow-up Intervals May Suffice for Mild Glaucoma

Extending follow-up intervals for glaucoma patients with stable disease may help reduce unnecessary visits and burden on the healthcare system as a whole, researchers suggest. Click image to enlarge. Eyecare providers tend to recommend frequent follow-ups for all patients with glaucoma, even though research shows most cases progress slowly. This practice may impose an unnecessary burden on the healthcare system and worsen disparities in access to care. While delayed follow-up has been linked to disease progression in unstable patients, a new study published in American Journal of Ophthalmology concluded that “conventionally recommended follow-up schedules may be excessive for the broader glaucoma population.” They found that, in general, patients whose follow-up intervals exceeded provider recommendations did not show higher odds of visual field progression.This was a retrospective cohort and matched case-control study using electronic health record and Humphrey visual field (HVF) data from 2014 to 2023. Inclusion criteria consisted of at least five HVF tests for the primary analysis (1,121 eyes from 600 patients), while a sensitivity-matched analysis included eyes with two or more HVF tests (856 matched eyes). Mean baseline age was 73.7 years, 50.2% were female and the mean provider-recommended follow-up interval was 166.8 days. Delayed follow-up for each visit was calculated using the following formula: actual visit date minus (prior visit date + recommended interval). A 15% grace period was applied to account for scheduling variability. Progression was defined as an HVF mean deviation slope ≤-0.5 dB/year.Over a mean follow-up of 7.3 years, HVF progression occurred in 19.8% of eyes with baseline mean deviation (MD) >-6 dB and 32.8% of eyes with baseline MD ≤-6 dB. Delayed follow-up was common: 53.4% of visits occurred after the provider-recommended interval, and the mean days of delayed follow-up per patient was 42.3 (mean maximum: 273.9 days).Importantly, in multivariable models across the full cohort, none of the delayed follow-up metrics (percentage of delayed visits, mean days delayed or maximum days delayed) were associated with higher odds of HVF progression. Independent predictors of progression included older age (per 10 years adjusted odds ratio [aOR]: 1.34), larger cup-to-disc ratio (per 0.1 increase aOR: 1.13), greater number of HVF tests (per test aOR: 1.02), shorter total follow-up length (per year aOR: 0.81) and having an unmet social determinant of health need (aOR: 1.88).While delayed follow-up wasn’t shown to increase the odds of HVF progression in glaucoma suspects and patients with mild disease, it did appear to worsen outcomes in moderate and severe glaucoma. In the matched case-control sensitivity analysis, among eyes with baseline MD ≤-6 dB, a mean delayed follow-up >60 days was associated with higher odds of progression (aOR: 1.95) and a maximum delayed follow-up >365 days showed a borderline association (aOR: 1.77). Still, the study authors pointed out that among patients with moderate or severe disease, close to 70% remained stable under provider supervision.“These findings suggest that glaucoma suspects and early-stage glaucoma patients may currently be seen more frequently than necessary,” the authors wrote in their paper on the findings. Instead, they advise eyecare providers to optimize follow-up intervals to meet each unique patient’s needs. “Patients who are not yet stable require closer monitoring, while follow-up intervals could likely be safely extended for those with stable disease,” they concluded, while adding that “care must be taken to ensure that these patients stay engaged in care to prevent unintended lapses in monitoring or total loss to follow-up.” The authors concluded, “By tailoring schedules based on disease severity and stability, clinical resources can be better utilized, reducing unnecessary visits for stable patients and improving access for high-risk or unstable patients.”Click here for the source. Kolli A, Chen E, Xu X, et al. Visual field progression in glaucoma patients with delayed follow-up. Am J Ophthalmol. May 14, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.