Identifying Risk Factors For Non-Attendance And Its Impact On Visual Outcomes In Cataract Clinic Patients

We aim to evaluate the clinical and demographic predictors of patients who "Did Not Attend" (DNA) appointments within our dedicated cataract service. This study quantifies the disparity in visual acuity (VA) and intraocular pressure (IOP) between attendees and non-attendees. By evaluating patients’ age, ethnicity, and distance from our site, we aim to identify high-risk individuals. This will aid us in creating targeted outreach strategies, optimising surgical scheduling and mitigating the risk of avoidable vision loss in cataract patients.

Our study was conducted within the Department of Ophthalmology at King’s College Hospital, London. Our centre is a high-volume tertiary referral centre and a major teaching hospital that serves a diverse population in South East London. We provide a comprehensive cataract service, managing both routine age-related cases and complex referrals, including traumatic and secondary cataracts.

A retrospective analysis of 3,228 cataract clinic appointments was performed. To ensure comparable group sizes for statistical robustness, data was collected from a 24-month cohort of patients who "Did Not Attend" (n=1,472) and compared against a 6-month cohort of attendees (n=1,756). Clinical markers included mean LogMAR VA and IOP. Demographic data, including age, ethnicity, and distance from the hospital were cross-referenced with our EHR records. Statistical analysis utilised Welch’s Independent Samples T-tests for continuous data and Chi-Square tests for categorical variables. Odds Ratios (OR) were calculated to assess age-related non-attendance risk.

Patients in the DNA group exhibited significantly worse visual acuity (0.36 vs 0.31 LogMAR; p < 0.001) and higher mean IOP (13.75 ± 6.07 vs 13.24 ± 4.45 mmHg; p < 0.001) than those who attended. The 19–30 age group demonstrated the highest DNA rate (66.7%, OR 2.53 vs 61–75 group; p = 0.012). Geographical analysis revealed a "proximity paradox": patients living within 2 miles had a significantly higher DNA rate (50.9%) than those travelling over 10 miles (38.5%; p = 0.033). Ethnicity played a role in the younger cohort, where both "Other” and “Not Stated" groups had a 100% DNA rate (p < 0.001). These findings suggest that younger, local patients are most likely to miss critical pre- or post-operative assessments.

Non-attendance in cataract clinics is associated with poorer visual metrics, potentially complicating surgical outcomes and timing. The higher DNA rate among local residents suggests that proximity may decrease the perceived "cost" of missing an appointment, leading to reduced compliance. Furthermore, the high non-attendance in the 19–30 age group, often those with traumatic or developmental cataracts, highlights a vulnerable demographic. Targeted interventions, such as localised digital outreach, are required to ensure timely surgical intervention and reduce the burden of avoidable visual impairment.