Risk Factors and Consequences of Lapses in Proliferative Diabetic Retinopathy Care in a National Cohort

OBJECTIVE To identify prevalence, risk factors, and visual outcomes associated with occurrence and duration of lapses in proliferative diabetic retinopathy (PDR) care. RESEARCH DESIGN AND METHODS This was a retrospective national cohort study (2008–2023) of adults with PDR and ≥6 months of follow-up who were participating in the Sight Outcomes Research Collaborative. We used multivariable regressions to assess factors associated with lapse occurrence and duration, and compared post-lapse visual acuity by lapse duration. RESULTS Among 15,211 individuals, 71.8% experienced a lapse in care; 14.2% of the lapses lasted >24 months. Lapses were more common among non-Hispanic Black, younger, and individuals with disability, and less common in those with poor vision or prior PDR treatment. Older age and PDR treatment predicted shorter lapses, and residence in distressed areas predicted longer lapses. Visual acuity worsened after lapses, with greater declines after longer lapses. CONCLUSIONS Prolonged lapses in PDR care are common, disproportionately affect vulnerable groups, and are associated with persistent vision loss.