The purpose of this study was to gain insights into why patients are not compliant with their glaucoma medications. Patients were recruited from lists provided by two ophthalmologists. Each patient had seen a minimum of two ophthalmologists for their glaucoma, and was taking at least two topical medications for glaucoma. Qualitative methodology was utilized, including two focus groups and eleven in-depth interviews in patients' homes. The results showed that forgetfulness was the number one reported reason for non-compliance. Patients did not claim to be non-compliant specifically because of side effects, but they did complain about them. Communication between physicians and patients is a key factor in compliance for glaucoma patients. Specifically, patients would like their physicians to teach them how to instill their eye drops, tell them about new/alternate medications and procedures as they become available, and offer new ways to make their regimen easier. Patients often do not tell their physician if they experience a side effect unless it is intolerable to them, yet they do realize the seriousness of glaucoma, and the consequences of not following their doctor's orders. Finally, while cost was not a reported deterrence to compliance, some patients would prefer less expensive alternatives.

To examine resource consumption and the direct costs of treating glaucoma at different disease severity levels. Design: Observational, retrospective cohort study based on medical record review. Participants: One hundred fifty-one records of patients with primary open-angle or normal-tension glaucoma, glaucoma suspect, or ocular hypertension (age Ն18 years) were randomly selected from 12 sites in the United States and stratified according to severity based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients had to have been followed up for a minimum of 5 years. Patients with concomitant ocular disease likely to affect glaucoma treatment-related resource consumption were excluded. Methods: Glaucoma severity was assessed and assigned using a 6-stage glaucoma staging system, modified from the Bascom Palmer (Hodapp-Anderson-Parrish) system. Clinical and resource use data were collected from the medical record review. Resource consumption for low-vision care and vision rehabilitation was estimated for patients with end-stage disease based on specialist surveys. For each stage of disease, publicly available economic data were then applied to assign resource valuation and estimate patientlevel direct costs from the payer perspective. Main Outcome Measures: Average annual resource use and estimated total annual direct cost of treatment were calculated at the patient level and stratified by stage of disease. Direct costs by specific resource types, including ophthalmology visits, glaucoma surgeries, medications, visual field examinations, and other glaucoma services, were also assessed. Results: Direct ophthalmology-related resource use, including ophthalmology visits, glaucoma surgeries, and medication use, increased as disease severity worsened. Average direct cost of treatment ranged from $623 per patient per year for glaucoma suspects or patients with early-stage disease to $2511 per patient per year for patients with end-stage disease. Medication costs composed the largest proportion of total direct cost for all stages of disease (range, 24%-61%). Conclusions: The study results suggest that resource use and direct cost of glaucoma management increase with worsening disease severity. Based on these findings, a glaucoma treatment that delays the progression of disease could have the potential to significantly reduce the health economic burden of this chronic disease over many years.

There is good correlation between the 2 methods of IOP measurement, even at extremes of IOP. The Icare instrument was easy to use and recorded rapid and consistent readings with minimal training. It seems to be more comfortable than GAT and obviates the need for topical anesthesia.

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