Reasons for Loss to Follow-Up in Thai Glaucoma Patients and Suspects

Glaucoma is a leading cause of irreversible blindness worldwide, and Thailand is no exception. Early detection and consistent follow-up are crucial to preventing vision loss. However, many Thai glaucoma patients and suspects fail to return for scheduled appointments, leading to disease progression and poorer outcomes. Understanding the reasons behind this loss to follow-up is essential for improving patient care and reducing preventable blindness.

What Is Loss to Follow-Up in Glaucoma?

Loss to follow-up (LTFU) occurs when patients diagnosed with or suspected of having glaucoma do not return for scheduled medical visits. This can result in delayed treatment, worsening symptoms, and irreversible vision damage. In Thailand, several factors contribute to this issue, ranging from socioeconomic barriers to healthcare system challenges.

Key Reasons for Loss to Follow-Up in Thai Glaucoma Patients

1. Financial Constraints

Many Thai patients, especially those in rural areas, face financial difficulties that prevent them from attending follow-up visits.

High out-of-pocket costs for consultations, medications, and transportation

Limited insurance coverage for chronic eye conditions

Loss of income due to frequent hospital visits

2. Geographical Barriers

Thailand’s healthcare infrastructure is unevenly distributed, with specialized glaucoma care concentrated in urban centers.

Long travel distances to tertiary hospitals

Poor public transportation in rural areas

Difficulty taking time off work for appointments

3. Lack of Awareness and Health Literacy

Glaucoma is often asymptomatic in early stages, leading patients to underestimate its severity.

Misconceptions that treatment is unnecessary if vision seems normal

Low awareness of glaucoma’s irreversible nature

Poor understanding of the importance of regular monitoring

4. Cultural Beliefs and Alternative Medicine

Some Thai patients rely on traditional remedies instead of medical treatment.

Preference for herbal treatments or spiritual healing

Distrust in Western medicine

Belief that glaucoma is a natural part of aging

5. Healthcare System Challenges

Systemic issues within Thailand’s healthcare system also contribute to LTFU.

Long wait times for specialist appointments

Insufficient patient education during initial diagnosis

Fragmented care between primary and tertiary hospitals

6. Psychological Factors

The fear and anxiety associated with a chronic disease can deter patients from follow-ups.

Denial of diagnosis

Fear of surgery or invasive treatments

Depression related to vision loss

Strategies to Reduce Loss to Follow-Up

Addressing these barriers requires a multi-faceted approach involving healthcare providers, policymakers, and community engagement.

1. Improving Affordability

Expanding insurance coverage for glaucoma medications and tests

Subsidizing transportation costs for rural patients

Offering telemedicine consultations to reduce travel burdens

2. Enhancing Patient Education

Community awareness campaigns on glaucoma risks

Clear communication from doctors about disease progression

Use of visual aids to explain treatment importance

3. Strengthening Healthcare Access

Decentralizing glaucoma care to regional hospitals

Training primary care doctors in basic glaucoma management

Implementing reminder systems for follow-up appointments

4. Cultural Sensitivity in Care

Incorporating traditional medicine discussions into treatment plans

Engaging local leaders to promote medical adherence

Providing counseling for patients with anxiety or depression

Conclusion

Loss to follow-up among Thai glaucoma patients and suspects is a complex issue influenced by financial, geographical, cultural, and systemic factors. Addressing these challenges requires collaborative efforts to make care more accessible, affordable, and culturally appropriate. By improving patient education, healthcare access, and financial support, Thailand can reduce preventable blindness and enhance the quality of life for glaucoma patients.

Early intervention saves vision—ensuring patients stay in care is the first step toward a brighter future for glaucoma management in Thailand.