Determinants of Medication Adherence to Topical Glaucoma Therapy

Abstract

Introduction/Purpose To determine the associations between medical, demographic, socioeconomic, and ocular factors and adherence to topical glaucoma ocular hypotensive therapy. Methods One-hundred and sixteen patients with ocular hypertension or open angle glaucoma from two tertiary glaucoma services participated in this prospective study. Adherence to ocular hypotensive therapy was measured using an electronic dose monitor (Travatan Dosing Aid, Alcon Laboratories Inc., Fort Worth, TX) and collected data at 3-months after enrollment. We used 3 different definitions of adherence: 1) Definition 1: the proportion of days taking the prescribed number of drops within 3 hours of the prescribed dosing time; 2) Definition 2: the proportion of days taking any drops within 3 hours of the prescribed dosing time; and 3) Definition 3: the proportion of days taking any drops within 6 hours of the prescribed dosing time. Univariate and multivariate models were used to determine the association between the three adherence definitions, medical, demographic, socioeconomic, and ocular factors at 3-month follow-up. The main outcome measures for this study were risk factors for poor objective medication adherence. Results Adherence, using Definition 1, Definition 2, and Definition 3, was 64%, 75%, and 80%, respectively. Age, total number of other eye diseases, and race were significantly associated with full treatment adherence (Definition 1), with race alone significantly predicting 11% of full treatment adherence. For Definition 2, age, income, level of education, and total number of eye diseases were significantly associated with partial adherence (3 hours), again race alone significantly predicted 15% of partial adherence (any drops within 3 hours). For Definition 3, race, income, level of education, and total number of other eye diseases significantly predicted partial adherence (any drops within 6 hours), both race and income predicted 19% of partial treatment adherence. Significant differences for adherence rates between patients of European descent and those of African descent were found for all three definitions with those who were less adherent more likely to be of African descent. Conclusions Electronic dose monitors provide important information regarding adherence to topical ocular hypotensive medications in glaucoma patients. Electronic dose monitors show low adherence in a significant number of participants. Future studies are needed to determine the reasons for these differences in health behaviors related to glaucoma treatment which should guide treatment of poor adherence with glaucoma therapy.

Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial

“…39 It is unfortunate that more reliable clinical outcome measures could not be used, but within the time scale and number of follow-up visits, it is unlikely that changes in the visual field or optic nerve head would reach significance. IOP recordings taken at clinic visits are known to be unreliable at predicting adherence as some patients pay more attention to medication taking immediately before and after clinic appointments; 16,43 however, as both IOP fluctuation and changes in clinical management correlated well with refill and self-report adherence, the authors believe their inclusion was justified for the time period available.…”

Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure

“…10 To increase compliance in glaucoma patients, approaches like electronic dosing aids, motivational-and patientcentered communication strategies, and video documentation are being used, but so far the results have been mixed. 15,17,[19][20][21][22] A study examining patient compliance for 3 months after providing an electronic dosing aid showed 96% adherence within the first 10 days; this decreased slightly to 86% compliance for the remainder of the study. 19 In a similar study, Dreer et al 20 found that when using an electronic dosing aid 80% of patients took some amount of drops within 6 hours of their prescribed dosing time, but only 64% took the prescribed amount of drops within 3 hours of the prescribed dosing time.…”

“…15,17,[19][20][21][22] A study examining patient compliance for 3 months after providing an electronic dosing aid showed 96% adherence within the first 10 days; this decreased slightly to 86% compliance for the remainder of the study. 19 In a similar study, Dreer et al 20 found that when using an electronic dosing aid 80% of patients took some amount of drops within 6 hours of their prescribed dosing time, but only 64% took the prescribed amount of drops within 3 hours of the prescribed dosing time. Hermann et al 57 determined adherence in patients aware of electronic monitoring was no different than in patients who were unaware (67.5% compared to 69.5%), while Okeke et al 58 showed 45% of study participants who were provided free medications and were aware they were being monitored took less than 75% of intended doses during the 3 month study.…”

“…6,8 This is most likely due to poor treatment adherence, suggesting alternative therapeutic options or delivery systems that increase patient compliance could be beneficial. 10,13,15,19,20,24,25 We developed a series of NSs (Fig. 1) that encapsulate ocular hypotensive drugs to provide extended-release treatments that could minimize patient noncompliance.…”

“…13 Multiple strategies have been used to increase compliance in glaucoma patients; however, poor drug adherence remains a major barrier to treatment. 15,17,[19][20][21][22][23] To address this issue and improve clinical outcomes, delivery systems for glaucoma drugs are being developed that would ideally provide prolonged drug effects while decreasing systemic exposure, side effects, and patient discomfort (reviewed by Knight and Lawrence 24 ). A recent study by Chong et al 25 determined the willingness of patients to accept intraocular injections in lieu of current glaucoma therapies.…”