PCD logo

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


A telemedicine screening visit was scheduled for 794 participants. Of these, 254 did not show up or cancelled the appointment. A separate 366 participants were walk-ins with no prior appointment. Thus a total of 906 participants were screened; of these, 551 had nonnormal images at the telemedicine screening visit, with 15 of these participants fast-tracked because of high intraocular pressure, 1 of whom declined further participation. 536 participants were invited to attend visit 2, the confirmatory visit. 189 participants did not attend visit 2; 347 did attend, and 17 of these consented to participate in the second phase of the study. A total of 344 participants were randomized: 172 to usual care, and 172 to enhanced care (the intervention). In the usual care group, 66 attended the final visit. In the enhanced care/intervention group 77 attended the final visit.

Figure 1.

Flow chart describing the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, indicating participant inclusion, exclusion, and randomization to the usual care group or enhanced intervention group.

Return to Article



A graph shows the percentage of visits attended over time for each of the 2 study groups. At Visit 3 the intervention group had a 74.4% attendance, and the usual care group had a 39.0% attendance. Thereafter the yearly attendance for both groups dropped over years 1, 2, and 3, with attendance in the intervention group of 18.6%, 20.9%, and 20.0% for these 3 years respectively versus attendance in the usual care group of 8.1%, 6.4%, and 4.0% for the same periods.

Figure 2.

Adherence to recommended follow-up schedule over time by intervention group. Visit 3 was the initial visit with the community ophthalmologist. Timely adherence to Visit 3 was defined as attendance within 12 months of randomization. Annual adherence in Years 1–3 was defined as having attended all recommended follow-up visits within 13 months based on the recommended follow-up at the visit closest to the beginning of the year.

Return to Article


The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

Page last reviewed: May 20, 2021