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Because the damaging effects of glaucoma are not always obvious, lack of treatment compliance is a major concern. Understanding patients, and tailoring treatment to ensure compliance, is paramount to their eye health.
Glaucoma is often called the ‘silent thief of sight’ because it causes irreversible damage to the eye before the subject is even aware. This disease, as we all know, first affects the peripheral vision, to which we are far less attuned than our central vision. People normally only become aware of the damaging effects in glaucoma’s advanced stages.
As a result, maintaining patient compliance with glaucoma medication has been poor. Many study results have reported that only a quarter to a half of patients maintain their medication regime for a year.1-3
There are multiple barriers to compliance, with one study finding 71 different barriers. These barriers may be divided into regimen factors, i.e., the cost, complexity, availability and side effects; patient factors, i.e., their level of education, ability to remember to administer the treatment, motivation and any co-existing conditions; provider factors, i.e., the level of satisfaction and trust in their practitioner and environmental factors, i.e., their current situation, including other life events and access to support.4
The complexity of a treatment regimen plays a significant role in compliance – the more complex the treatment, the more compliance decreases. A patient on a single drop with once daily dosing will find it easier to adhere to their treatment than someone on multiple drops and multiple administrations per day. Increased age is associated with increased risk of glaucoma, but also of other comorbidities.
While a couple of drops a day may not seem difficult to recall, it may be overwhelming for a patient who already takes a plethora of other medications. It is also important to be mindful of the patient’s personal situation. For example, a patient who lives a stressful life, or is a carer for others, may fail to prioritise their own health, and may neglect adhering to their treatment plan, including returning for follow-up appointments.
A patient needs to understand the implications of glaucoma, including its irreversible nature.Patients that do not have this first-hand experience, or understanding of the disease, need to be adequately educated. However, it is not simply a matter of handing them information and expecting them to get it. Trust in the practitioner and the treatment regime is paramount in maintaining compliance. Taking the time to develop rapport and a relationship is crucial as glaucoma is a chronic disease which requires lifetime monitoring and treatment.
Seeing the light
Traditionally, the first line of treatment for primary angle open glaucoma (POAG) and ocular hypertension has been IOP lowering eye drops. While they have been very effective, they have been known to cause adverse reactions on the ocular surface due to toxicity. Surgery has typically been reserved for cases which were non-responsive to drop therapy. However, the Laser in glaucoma and ocular hypertension (LiGHT) study5 has shown that selective laser trabeculoplasty (SLT) has been very effective as a sustained IOP lowering procedure, with an excellent ocular safety profile. It has been argued that SLT should be considered first line treatment for POAG due to its low rate of adverse events, as well as reducing the risk of non-compliance by not requiring the patient to adhere to a treatment regime.
This article has been republished courtesy of www.mivision.com.au
References
1. Schwartz GF. Compliance and persistency in glaucoma follow-up treatment. CurrOpinOphthalmol. 2005;16:114-121.
2. Nordstrom BL, Friedman DS, Mozaffari E et al. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol. 2005; 140: 598-606.
3. Okeke CO, Quigley HA, Jampel HD, Ying GS, Plyler RJ, Jiang Y, et al. Adherence with Topical Glaucoma Medication Monitored Electronically: The Travatan Dosing Aid Study. Ophthalmology 2009;116:191-9.
4. Tsai JC. Medication adherence in glaucoma: approaches for optimizing patient compliance. CurrOpinOphthalmol. 2006; 17: 190-195.
During the past decade, glaucoma care in the UK has changed dramatically, with more non-medical ophthalmic practitioners involved. As such, optometrists and other non-medical professionals have been delivering laser treatments including SLT in the Hospital Eye Service (HES).
Sustained drug delivery via an implant could reduce the reliance on daily eye drops and ensure that the correct amount of medicine is delivered consistently, every day.
With the rising numbers of patients diagnosed with glaucoma – and oversubscription of public ophthalmology departments – the Glaucoma Community Collaborative Care Program at the Royal Victorian Eye and Ear Hospital in Melbourne is designed to alleviate some of this pressure.