AGE-RELATED MACULAR DEGENERATION INJECTION FREQUENCY Effects of Distance Traveled and Travel Support

Purpose: Although efficacious, intravitreal antivascular endothelial growth factor therapy regimens for neovascular age-related macular degeneration can prove difficult for patients to adhere to because of high cost and burden of transportation. Methods: Analysis of electronic health record data from the San Francisco Veterans Administration Medical Center eye clinic (January 1, 2010 to December 31, 2019) was performed, extracting demographic data, antivascular endothelial growth factor injection history, and enrollment in the SFVA travel benefit program. Two-tailed P-values were calculated for Poisson regression examining average number of injections per year as the outcome and distance traveled as the primary predictor. Travel benefit was evaluated as a modifying effect on the distanceinjection relationship. Results: Three hundred and eighteen patients who received intravitreal injection for treatment of neovascular age-related macular degeneration were included in the analysis. Median (interquartile range) distance to clinic was 31.5 miles (7.469.4 miles). Driving distance in miles was inversely associated with average number of injections per year. Among all 318 patients, for every additional 100 miles a patient lived from our clinic, the patient received on average 2.5 fewer injections per year (beta(distance) = -0.0025, P < 0.001), but this was not the case for patients with travel benefits (beta(distance) = -0.0011, P = 0.362). Conclusion: The greater the distance from a patient's eye clinic, the lower the average number of injections per year. However, travel benefits mitigated this relationship, highlighting opportunities for improving patient's adherence through assistance programs.