Predictors and Patient-Reported Reasons for Missed Appointments in an Urban Ophthalmology Center.

PURPOSE: To examine adult ophthalmology appointments at New York Eye and Ear Infirmary of Mount Sinai (NYEE) to identify structural and logistical factors associated with no-shows. METHODS: We conducted a retrospective cross-sectional mixed-methods study of electronic health record data for adult appointments between January 1 and December 31, 2025 (n = 62,678). Demographic, socioeconomic, geographic, and appointment characteristics were extracted from the electronic health record. Generalized estimating equations were used to identify predictors of no-show while accounting for repeated appointments by the same patient. A subset of glaucoma patients who missed appointments participated in routine quality improvement follow-up calls documenting reasons for missed visits. The primary outcome was appointment attendance; the secondary outcome was patient-reported reasons for missed appointments. RESULTS: The overall no-show rate was 16.9%. Medicaid/Public insurance, Self-Pay/Charity status, higher neighborhood social vulnerability, afternoon appointments, and several ophthalmic subspecialties were independently associated with greater odds of no-show. Younger age was also associated with increased no-show risk, whereas travel distance was not associated with a clinically meaningful increase in missed appointments. Among 67 patients reached through follow-up calls, the most commonly reported reasons for missed visits were forgetting the appointment, health or family emergencies, and scheduling conflicts. CONCLUSION: Missed ophthalmology appointments are driven by both structural socioeconomic disadvantage and immediate logistical barriers. Combining large-scale electronic health record analyses with patient-reported perspectives supports the development of targeted, equity-focused interventions.