The Association Between Compliance With Recommended Follow-up and Glaucomatous Disease Severity in a County Hospital Population

Abstract

Purpose To assess the association between insufficient follow-up and clinical parameters such as disease severity and medication use among glaucoma patients at a metropolitan county hospital. Design Cross-sectional study Methods Two-hundred and six patients with established glaucoma were recruited from San Francisco General Hospital. Subjects were classified based upon compliance with recommended follow-up examination intervals over the year preceding commencement of the study as determined by patient medical records. Glaucoma severity was determined based upon the American Academy of Ophthalmology Preferred Practice Patterns guidelines. Multivariate logistic regression analysis was used to assess the relationship between adherence with follow-up visits and disease severity. Results After adjustment for the impact of potential confounding variables, subjects with severe glaucomatous disease were found to have been less adherent to their recommended follow-up than those patients with mild or moderate glaucomatous disease (adjusted OR 1.89, 95% CI 1.21–2.94; P = .01). Subjects who were on glaucoma medications were found to be less adherent to follow-up recommendations (adjusted OR 3.29, 95% CI 1.41–7.65, P = .01). Conclusion Subjects with poor follow-up adherence were significantly more likely to have severe glaucomatous disease suggesting that poor follow-up may contribute to disease worsening or, alternatively, those with more severe disease are less inclined to follow up at appropriate intervals.

Understanding the reasons for loss to follow-up in patients with glaucoma at a tertiary referral teaching hospital in Korea

“…The higher incidence of loss to follow-up among patients with lower baseline IOP was consistent with the result of a previous study, which is that patients with an early stage of glaucoma or those who had not been prescribed an ocular hypotensive therapy had a higher risk for loss to follow-up 16. These results contrast with those of Ung et al ,14 who showed that patients with poor follow-up were significantly more likely to have severe glaucomatous disease. There are several reasons for these disparate results, one of which is differing demographic characteristics between study subjects.…”

“…The importance of adherence to follow-up regimens is highlighted in several studies, all of which found an association between worsening glaucoma severity and poor follow-up 14 15. In the present study, performed at a tertiary referral teaching hospital, we evaluated the proportion of patients with glaucoma who were lost to follow-up, and found that the incidence was 3.61% across 2 years.…”

“…A prior study in rural South India showed that 86.5% of newly diagnosed patients with glaucoma lacked appropriate clinical follow-up at 1 year 20. In a study on a metropolitan county hospital in the USA, 59.7% of established patients with glaucoma were classified as ‘poor follow-up’ 14. There are several possible reasons for these disparate results among studies.…”

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

“…Previous research has shown that this population is less likely than other patient groups to obtain ocular examinations from an ophthalmologist. [32][33][34][35] The bilateral strategy ensures these patients receive treatment for both eyes when necessary.…”

Why Patients With Glaucoma Lose Vision: The Patient Perspective

“…Poor adherence to medications is a multifactorial issue, and previous studies have identified many barriers to glaucoma medication adherence including cost 5–8 ; forgetfulness 5,6,8–10 ; side effects 6,8,10,11 ; difficulty instilling eye drops 5,6,8–11 ; skepticism that glaucoma will cause vision loss 5,9,12 ; skepticism that glaucoma medications are effective 5,9,11,12 ; a lack of knowledge about glaucoma 5,6,9,13 ; a lack of self-efficacy 9,14 ; difficulties with the medication schedule 6,8,10 ; a poor doctor patient relationship 15 ; and perceived life stress 16 . Ung and colleagues found that those with less severe disease were less adherent to their medications 17 , while those with more severe disease were less adherent with their follow-up care 18 , indicating that there may be different issues that face glaucoma patients early and later in their disease process.…”