[by Julie Monroe, MSN, AGNP-C, American Academy of Ophthalmology EyeNet Magazine, News in Review, p. 14-15, April 2026]
SENDING A BRIEF MESSAGE THROUGH an electronic patient portal, letting patients know that they are overdue for an eye appointment, helped reengage patients with glaucoma who had been lost to follow-up.
The findings, published in the journal Ophthalmology Glaucoma,1 suggest that a simple, low-cost, one-time message sent via an EHR patient portal can help mitigate loss to follow-up, said study author Andrew M. Williams, MD, Associate Professor of Ophthalmology at the University of Pittsburgh School of Medicine.
“In glaucoma care, it is a big problem, and we wanted to pilot a solution because gaps in care are associated with a higher risk for disease progression and blindness,” said Williams. “We can help mitigate loss to follow-up from glaucoma care by reminding patients about upcoming visits and reaching out when appointments are missed,” he said, adding that it’s also an opportunity to screen for unmet social issues that may be barriers to follow-up care.
Methodology. The study included 2,091 glaucoma patients with active EHR portals, of which 184 patients had been lost to follow-up. The lost-to-follow-up group was defined as “individuals with no completed or upcoming ophthalmology encounter since their 2023 visit (at the time of review in June 2025), documented transfer of eye care, or death,” the authors wrote.
After accounting for 44 people who died and 23 who had reported transferring their care, the remaining 117 patients received a follow-up message —a 40-word reminder note that included an appointment-scheduling phone number or a prompt to schedule by replying to the portal message.
“We kept our message simple with a brief sentence that follow-up is important for glaucoma care and that our records indicated that the patient appeared overdue for an eye exam,” Williams said.
The primary outcome was reengagement — defined as a completed visit or upcoming appointment at the eye clinic, or a request for a medication refill — within a month of receiving the message, the researchers wrote.
Study results. Of the 117 patients lost to follow-up who received the intervention message, 5 self-reported transferring their care, 50 (44.6%) of the patients “read” the message within 30 days of receiving it, and 62 did not read the message. Of those who read the message, 8 scheduled ophthalmology appointments, 2 scheduled optometry appointments, and 1 placed a request to schedule an appointment. In the “unread” message group, 2 patients requested medication refills and 1 scheduled an ophthalmology appointment. The overall rate of reengagement was 12.5%.
Cost-effective effort. The study authors estimated that the effort was cost-and time-effective. It required only 3 minutes per patient to prepare each message, “yielding a cost estimate of approximately $1.10/message, or $128.70 total.” Institution-level costs were offset by payments from 12 patients who scheduled an office visit after the HER message intervention. “For our payor mix, these charges yield a prospective net revenue of $1,764.80, with 7% cost as a percent of net revenue,” the researchers wrote.
“The strength of using the EHR to reengage patients is its simplicity and low cost,” said Pradeep Ramulu, MD, PhD, Chief of the Glaucoma Division at Wilmer Eye Institute at Johns Hopkins Medicine, in Baltimore.
Ramulu, who was not involved with the study, said, “While it succeeds in just a fraction of patients, spending a few dollars to potentially save someone’s sight is certainly appealing.”
Limitations. The message was sent in English and involved only patients with an active patient portal account. It also did not include a control group, and it involved just one academic medical center, so the findings may not be generalizable, the authors noted.
Other considerations. Ramulu said that many glaucoma patients are over-treated, so it would be useful to know if those people who are lost to follow-up have early, well-controlled disease or not.
“If those are the ones who stop follow-up, perhaps they may be making a reasonable decision,” he said.
Ramulu added that more research is needed in order to better understand the reasons patients are lost to follow-up.
Williams said the scope of the loss to follow-up problem can feel daunting, but the study design is simple and low cost, so it could be a reasonable intervention. It “provides a pathway for a potential solution to mitigate loss to follow-up of glaucoma patients.”
1 Schulman A et al. Ophthalmol Glaucoma.
Published online Jan. 9, 2026. doi.org/10.1016/j.
ogla.2026.01.002.
Relevant financial disclosures: Ramulu—Alcon: C; Perfuse Therapeutics: S; Topcon: S; WL Gore: C. Williams—American Academy of Ophthalmology: S; American Glaucoma Society: S; Eye & Ear Foundation of Pittsburgh: S; Glaukos: C; National Science Foundation: S; Research to Prevent Blindness: S.