Socioeconomic, age disparities found in retina practice patient dismissals | ASRS 2026

Patients dismissed from a retina-only private practice tend to be younger, male, from lower-income areas and have a higher social deprivation index, according to an abstract presented at the annual meeting of the American Society of Retina Specialists (ASRS) being held July 16 through July 18, 2026, in Montreal.

‘Characteristics of Patients Dismissed From a Retina Practice’ was presented by lead author, Michael Nguyen, M.D., of Vanderbilt University.

Nguyen and his team examined dismissal patterns among 174,250 patients seen at a single-specialty retina practice from August 1, 2017, to June 30, 2024.

The researchers set out to identify which demographic, clinical, and behavioral factors were associated with formal patient dismissal from ongoing care. This question is especially relevant for retina practices, where patients often require years of recurring visits and injections to manage chronic, vision-threatening conditions. The study team compared 432 dismissed patients against the broader retained patient population, analyzing dismissal reasons alongside diagnoses, treatment histories, and demographic data collected over the full seven-year study window.

Patient dismissals were infrequent—of the 174,250 patients evaluated during the study period, 432 (0.25%) were formally dismissed from the practice. Noncompliance with medical recommendations was the leading cause, accounting for 260 dismissals (60.2% of cases). Aggressive or inappropriate behavior was the second most common reason, cited in 79 cases (18.2%).

Beyond the reasons for dismissal itself, the demographic profile of dismissed patients diverged notably from that of retained patients. Dismissed patients averaged 55.9 years old, nearly 11 years younger than the 66.3-year average among retained patients. They were also more likely to be male (56.9%). Zip code-based analysis of adjusted gross income also showed a gap, with dismissed patients averaging $93,124 compared with $109,431 for retained patients. The social deprivation index, a measure of socioeconomic disadvantage, was higher among dismissed patients as well, at 43.4 versus 35.1. Taken together, these figures point to a consistent socioeconomic gradient separating the two groups.

Clinically, diabetic retinopathy stood out as significantly more common in the dismissed group, present in 26.9% of dismissed patients compared to just 9.9% of retained patients, a condition that typically requires frequent monitoring and strict treatment adherence. Because diabetic retinopathy management depends heavily on consistent follow-up, this disparity suggests that some of the very patients most in need of ongoing retina care are also the most likely to lose access to it.

Though dismissals affected a small fraction of the overall patient population, the researchers noted the pattern raises questions about equity in retinal care delivery. Patients with diabetic retinopathy who lose access to a specialty practice face particular risk, given the disease's potential to progress toward vision loss without consistent management. Gaps in continuity of care may compound existing disparities, since patients who are already navigating socioeconomic barriers are the ones least likely to find replacement specialty care quickly.

The study authors suggested that practices might reduce dismissal rates and, by extension, improve continuity of care by addressing socioeconomic barriers that contribute to noncompliance rather than treating missed appointments or unmet recommendations solely as behavioral failures on the patient's part. Interventions such as transportation assistance, flexible scheduling or enhanced care coordination could help retain patients who might otherwise be dismissed for reasons rooted in access rather than unwillingness to follow care plans.