Abstract: Objective This real-world study investigates the impact of treatment adherence on long-term visual prognosis among patients undergoing intravitreal injection therapy. It aims to identify key factors influencing adherence to inform the development of preventative strategies against visual impairment. Methods A retrospective analysis was conducted on patients receiving intravitreal injections at a hospital in Cangzhou City between April 2022 and March 2024. Based on their final visual acuity at the 12-month follow-up after initial treatment, patients were stratified into a poor prognosis group (n=72) and a good prognosis group (n=232). A logistic regression model was constructed to analyze the effect of treatment adherence on visual outcomes. Results The mean treatment adherence score in the poor prognosis group was significantly lower than that in the good prognosis group (5.58±0.86 vs. 6.26±0.72; t=5.977, P<0.01). The median adherence score for the entire cohort of 304 patients was 6.25. Patients were dichotomized based on this median score into a high-adherence group (Q1, n=156, score ≥6.25) and a low-adherence group (Q2, n=148, score <6.25). In an unadjusted model, the risk of poor visual prognosis was 2.640 times higher in the Q2 group compared to the Q1 group (OR=2.640, 95% CI: 1.516-4.597). After adjusting for confounding factors, the risk in the Q2 group remained significantly elevated at 2.894 times that of the Q1 group (OR=2.894, 95% CI: 1.064-7.875). These findings indicate a substantive association between diminished treatment adherence and an increased risk of adverse visual outcomes in this patient population. Conclusions Treatment adherence is a critical determinant of visual prognosis in patients receiving intravitreal injections. Non-adherence significantly elevates the risk of poor long-term visual outcomes. By identifying the factors that undermine adherence, targeted interventions can be designed for high-risk populations and critical deficiencies in care pathways, thereby enhancing treatment adherence and preserving long-term vision.

Key words: Intravitreal injection, Visual acuity, Treatment adherence, Relationship, Influencing factors, Real-world study