May 05 2011
Programs to Optimize Adherence in Glaucoma
Studies indicate that reduced IOP and consistent minimization of diurnal fluctuation can aid in the control of POAG. Use of medication is the most common method to achieve control of IOP. The great unknown for the clinician has been the consistency of use of medication by our patients. This study reviews many of the resources currently available to patients and doctors to increase adherence to a medical treatment plan of glaucoma.
Adherence to glaucoma medication treatment range from below 50% in one large study of insurance data to patient self-reported adherence of 97% in another study. Interestingly, this patient self-reporting group was ultimately found to be only 76% adherent. In another study, patients were given an electronic eye drop monitoring device and free medication to continue their glaucoma treatment. Yet, even with the knowledge of the monitoring and free medication, approximately half the participants used their drops less than 75% of the recommended dosing.
This study reports a number of approaches that have been developed to address the adherence to chronic medical treatments. Many different patient education brochures are available from the National Institute of Health, the National Eye Institute, Prevent Blindness America, Pfizer, the American Optometric Association and the American Academy of Ophthalmology. Videos and web materials are also available.
Glaucoma incidence increases with age. Unfortunately, so does forgetfulness and infirmity. To help forgetful patients, personalized, automated phone and electronic reminders are available from companies such as Smile Reminder and Transmedia. A simple home reminder device is the Lumigan Compliance Aid available from Allergan. This device holds a bottle of Lumigan and flashes or sounds an alarm when the bottle is not removed from the device each day.
The study also describes devices that aid in the delivery of medication. The Xal-Ease Delivery Aid is available from Pfizer. The Travatan Dosing Aid from Alcon uses a micro-processor to monitor date and time of dose, emit visual and audio daily alarm reminders and has a lever to help delivery of the eye drop. This device is no longer produced but the article indicates that it may be available from Alcon. Other devices are available from Opticare and Mystic Pharmaceutical.
Future delivery devices such as punctum plugs and contact lens delivery systems are also described in this paper. Reference to nanomolecules that can safely pass the blood-brain barrier make a non-toxic tool for drug delivery are touched upon. The European availability of the Triggerfish Continuous IOP Monitoring system holds great promise of giving us an accurate measurement of diurnal pressures is also described.
With the technological advancements that are becoming available to increase adherence to glaucoma treatment, it is interesting to note that this study reports on the work of Kharod that demonstrates up to a 23% increase in adherence to treatment by the simplest of educational aids: the written word. Just writing your instructions for the patient to have at home can be a wonderful aid to adherence!
This study also gives a succinct summary page with contact information for many products currently available to promote adherence.
Citation: Dianne Kowing, OD; Dawn Messer, OD; Scott Slagle, OD; Alyon Wasik, OD. Programs to optimize adherence in glaucoma. Optometry, July 2010, 81(7), 339-350.