{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:23:12Z","timestamp":1787840592185,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11]]},"abstract":"\n Purpose:<\/jats:title>\n To determine the factors associated with compliance with recommended intravitreal injections (IVIs) for retinal diseases among out-of-pocket, insured, and fully subsidized (non-paying) patients.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This retrospective observational hospital-based study included patients recommended for IVI in at least one eye between November 2011 and May 2022. Three cohorts of patients were assessed: out-of-pocket payers, insured, and those fully subsidized (non-paying) by the hospital. The main outcome measure was the compliance rate, defined as the proportion of patients receiving an injection after one was recommended. The impact on the visual outcome in each cohort was a secondary outcome.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Overall, 50,408 IVI were recommended for at least one eye and were included in the analyses. Male patients were more common (66.72%), and the mean age was 55.36 \u00b1 16.39 years. The overall compliance rate with the first recommended injection was 51.37%, which increased and eventually stabilized with subsequent recommendations to approximately 80% (range: 77.48%\u201382.93%). Insured patients had a higher compliance rate with the first recommendation compared to the non-insured (100% vs. 49.84%;\n P<\/jats:italic>\n < 0.000\n 01<\/jats:italic>\n ), and non-paying patients had a higher compliance rate after the first recommendation compared to paying patients (62.51% vs. 48.66%;\n P<\/jats:italic>\n < 0.000\n 01<\/jats:italic>\n ). Patients with insurance achieved a better visual outcome at the last follow-up compared to other cohorts.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Insured patients have a much higher compliance rate with recommended IVIs compared to out-of-pocket or non-paying patients. The high non-compliance rate among non-paying patients suggests that factors other than the direct cost of the injections may impact compliance with recommended treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijo.ijo_671_25","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T19:00:19Z","timestamp":1758308419000},"page":"1647-1652","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Factors determining compliance with recommended intravitreal injections for retinal diseases among out-of-pocket, fully subsidized (non-paying), and insured patients: Real-world evidence from India"],"prefix":"10.4103","volume":"73","author":[{"given":"Anthony V","family":"Das","sequence":"first","affiliation":[{"name":"Indian Health Outcomes, Public Health and Economics Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India"},{"name":"Department of EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brijesh","family":"Kashyap","sequence":"additional","affiliation":[{"name":"Florida Blue, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brijesh","family":"Takkar","sequence":"additional","affiliation":[{"name":"Indian Health Outcomes, Public Health and Economics Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India"},{"name":"Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragukumar","family":"Venugopal","sequence":"additional","affiliation":[{"name":"Indian Health Outcomes, Public Health and Economics Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India"},{"name":"Department of EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirantan","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Science Policy Research Unit University of Sussex Business School Brighton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehul C","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Harvard Medical School, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudlavalleti V S","family":"Murthy","sequence":"additional","affiliation":[{"name":"Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit C","family":"Khanna","sequence":"additional","affiliation":[{"name":"Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Center for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taraprasad","family":"Das","sequence":"additional","affiliation":[{"name":"Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja","family":"Narayanan","sequence":"additional","affiliation":[{"name":"Indian Health Outcomes, Public Health and Economics Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India"},{"name":"Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"R1-20260419","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1517\/14728214.2014.884559","article-title":"Emerging treatments for wet age-related macular degeneration","volume":"19","author":"Smith","year":"2014","journal-title":"Expert Opin Emerg Drugs"},{"key":"R2-20260419","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1001\/jamaophthalmol.2019.4557","article-title":"Economic value of anti-vascular endothelial growth factor treatment for patients with wet age-related macular degeneration in the United States","volume":"138","author":"Mulligan","year":"2020","journal-title":"JAMA Ophthalmol"},{"key":"R6-20260419","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.4103\/ijo.IJO_1866_19","article-title":"Factors affecting compliance to intravitreal anti-vascular endothelial growth factor therapy in Indian patients with retinal vein occlusion, age-related macular degeneration, and diabetic macular edema","volume":"68","author":"Kelkar","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"R7-20260419","doi-asserted-by":"crossref","first-page":"396","DOI":"10.4103\/0301-4738.100533","article-title":"Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience","volume":"60","author":"Rao","year":"2012","journal-title":"Indian J Ophthalmol"},{"key":"R8-20260419","doi-asserted-by":"crossref","first-page":"427","DOI":"10.4103\/ijo.IJO_710_19","article-title":"Big data and the eyeSmart electronic medical record system-An 8-year experience from a three-tier eye care network in India","volume":"68","author":"Das","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"R9-20260419","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jtos.2019.02.007","article-title":"Incidence, demographics, types and risk factors of dry eye disease in India: Electronic medical records driven big data analytics report I","volume":"17","author":"Donthineni","year":"2019","journal-title":"Ocul Surf"},{"key":"R11-20260419","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1186\/s12913-022-08509-x","article-title":"Multimorbidity, healthcare use and catastrophic health expenditure by households in India: A cross-section analysis of self-reported morbidity from national sample survey data 2017-18","volume":"22","author":"Karan","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"R12-20260419","doi-asserted-by":"crossref","first-page":"116","DOI":"10.4103\/ijcm.ijcm_783_21","article-title":"Factors associated with out-of-pocket expenditure among patients admitted for cataract surgery under district blindness control society scheme: A cross-sectional study from a private medical college hospital of South India","volume":"47","author":"Shambhu","year":"2022","journal-title":"Indian J Community Med"},{"key":"R13-20260419","doi-asserted-by":"crossref","first-page":"e2210040","DOI":"10.1001\/jamanetworkopen.2022.10040","article-title":"Components of out-of-pocket expenditure and their relative contribution to economic burden of diseases in India","volume":"5","author":"Ambade","year":"2022","journal-title":"JAMA Netw Open"},{"key":"R18-20260419","doi-asserted-by":"crossref","first-page":"61","DOI":"10.25259\/IHOPEJO_25_2022","article-title":"National health transformations","volume":"1","author":"Narayanan","year":"2022","journal-title":"IHOPE J Ophthalmol"},{"key":"R19-20260419","doi-asserted-by":"crossref","first-page":"e001188","DOI":"10.1136\/bmjophth-2022-001188","article-title":"Quantifying burden of intravitreal injections: questionnaire assessment of life impact of treatment by intravitreal injections (QUALITII)","volume":"7","author":"Wang","year":"2022","journal-title":"BMJ Open Ophthalmol"},{"key":"R20-20260419","doi-asserted-by":"crossref","first-page":"e0241475","DOI":"10.1371\/journal.pone.0241475","article-title":"Impact of the affordable care act on utilization of benefits of eye care and primary care examinations","volume":"15","author":"Pang","year":"2020","journal-title":"PLoS One"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_671_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:25:35Z","timestamp":1787837135000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_671_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,19]]},"references-count":12,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_671_25","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,19]]},"assertion":[{"value":"2025-03-12","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}