A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma

Benjamin E. Leiby, Sarah E. Hegarty, Tingting Zhan, Jonathan S. Myers, L. Jay Katz, Julia A. Haller, Michael Waisbourd, Christine Burns, Meskerem Divers, Jeanne Molineaux, Jeffrey Henderer, Charles Brodowski, Lisa A. Hark

Research output: Contribution to journalArticlepeer-review


Introduction Appointment nonadherence is common among people with glauc- oma, making it difficult for eye care providers to monitor glauc- oma progression. Our objective was to determine whether the use of patient navigators, in conjunction with social worker support, could increase adherence to recommended follow-up eye appoint- ments. Methods A randomized, controlled trial evaluated the effectiveness of an in- tervention that used patient navigators and social workers to im- prove patient adherence to follow-up eye care compared with usu- al care. Participants with glaucoma and other eye diseases (N = 344) were identified at primary care clinics in community settings through telemedicine screening of imaging and then randomized to enhanced intervention (EI) or usual care (UC). Data on parti- cipants’ visits with local ophthalmologists were collected for up to 3 years from randomization. Groups were compared for timely at- tendance at the first visit with the local ophthalmologist and adher- ence to recommended follow-up visits. Results Timely attendance at the first visit was higher for EI than UC (74.4% vs 39.0%; average relative risk [aRR] = 1.85; 95% CI, 1.51–2.28; P <.001). Rates of adherence to recommended annual follow-up during year 1 were 18.6% in the EI group and 8.1% in the usual care group (aRR = 2.08; 95% CI, 1.14–3.76; P =.02). The aRR across years 2 and 3 was 3.92 (95% CI, 1.24–12.43; P =.02). Conclusion An intervention using patient navigators and social workers doubled the rate of adherence to annual recommended follow-up eye care compared with usual care in community settings, and was effective at increasing connections with local ophthalmologists. Interventions to further improve long-term adherence are needed.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalPreventing chronic disease
StatePublished - 2021


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