title: Lost to follow-up for appointments in a dedicated dry eye clinic.
abstract: OBJECTIVE
  Dry eye is a prevalent condition with significant socioeconomic burden. This study evaluates the extent and reasons for loss to follow-up (LTF) in a dedicated dry eye clinic. LTF refers to patient who discontinued visits for >2 years.
  
  
  METHODS
  The proportion of patients LTF and the demographics in a cohort of dry eye patients (2006 to 2010) were determined. A telephone survey was prospectively conducted for patients who were LTF.
  
  
  RESULTS
  Of 505 patients, 240 (47.5%) were LTF. Associated demographic factors for LTF were male sex, non-Chinese ethnicity, and age group <30 years old (all P<0.05). The reasons for LTF through the telephone survey (response rate 77.9%) were categorized into three broad groups, stabilized dry eye condition (47%), personal/social factors (25%) and perceived insufficiency of healthcare delivery (28%). Only two (1.1%) were considered as management failures. The younger patients (age <50 years) were more likely to become LTF (P<0.001) due to stabilized dry eye disease, compared to older patients who were more likely to be LTF due to personal/social reasons (P=0.02). Poor communication and service factors under healthcare delivery were found to be higher (P=0.002) in those who visited once before they were LTF (8.5%) compared to those who visited multiple times before they were LTF (0.1%).
  
  
  CONCLUSIONS
  LTF was relatively common in hospital-based dry eye management. Female and older patients were less likely to stop consultation. Stabilized dry eye condition, common in younger patients, was the most common reason for LTF. Elderly patients have difficulty attending clinics due to nonmedical problems, which may require a more holistic approach.
authors.affiliation: Singapore Eye Research Institute, Singapore.
authors.forename: Kip Hoe
authors.initials: KH
authors.lastname: Poon
authors.affiliation: Singapore Eye Research Institute, Singapore.
authors.forename: Sharon
authors.initials: S
authors.lastname: Yeo
authors.affiliation: Singapore Eye Research Institute, Singapore ; Singapore National Eye Centre, Singapore ; Yong Loo Lin School of Medicine, Singapore ; Duke-NUS Graduate Medical School, Singapore.
authors.forename: Louis
authors.initials: L
authors.lastname: Tong
keywords: clinical study; cohort study; health services utilization; human; public health