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Study identifies factors associated with poor glaucoma treatment compliance
Lack of motivation in younger patients, poor eye drop technique in older patients to blame.
Younger glaucoma patients tend to underestimate the severity of glaucoma and are therefore more likely to be non-adherent to treatment, according to a study initiated by Florent Aptel, MD, and Philippe Denis, MD, PhD, at the Edouard Herriot Hospital in Lyon, France. In addition, older patients tend to have a poor application technique and therefore miss the necessary dosage they require.
“Treatment compliance is a major problem with chronic diseases like glaucoma,” Dr. Aptel said at the annual meeting of the French Society of Ophthalmology.
A cohort of 138 glaucoma patients with chronic open-angle glaucoma or ocular hypertension was enrolled in a university-affiliated glaucoma center. Visual field testing was performed for each patient, and each patient’s technique of eye drop instillation was examined.
Finally, patients were asked to fill out two questionnaires, the first concerning quality of life and the second concerning treatment compliance.
Self-administration difficulties
As with all medication regimes, patients need to be willing and able to instill their eye drops if they are to maximize the therapeutic benefits. The study demonstrated that many patients have difficulties with self-administration of the drugs. Nearly 20% of the patients instilled their eye drops outside the eye, and only 23% instilled them correctly into the conjunctival sac. In 33% of the patients, the eye drops poured out of the eye after instillation.
Poor compliance
The rate of declared non-adherence to treatment was about 25% in this study.
“Poor compliance was attributed by the patients to office hours, to the side effects of medications, to doubts on the efficacy of the treatment, to the price of medications and to lack of information,” Dr. Aptel said.
Fixed combinations and single-dose medications requiring only one daily administration, such as prostaglandin, were less frequently associated with non-adherence. As far as compliance and motivation to treatment, older patients did significantly better.
“They tend to be more regular and more aware of the severity of the disease,” Dr. Aptel said.
Older age is also more frequently associated with more advanced stages of glaucoma and with glaucomatous visual field defects, which increase the awareness of patients about their condition.
“Objective visual field data, like computerized perimetry measurements, are crucial in making the patient aware of the presence and severity of the disease and of its consequences,” Dr. Aptel said.
For more information:
- Florent Aptel, MD, can be reached at Hôpital Edouard Herriot, 5, Place Arsonval, 69003 Lyon, France; +33-4-72-11-62-36; e-mail: aptel_florent@hotmail.com. Drs. Aptel and Denis have no direct financial interest in the products mentioned in this article, nor are they paid consultants for any companies mentioned. There is no source of financial support for the study.
- Michela Cimberle is an OSN Correspondent based in Treviso, Italy, who covers all aspects of ophthalmology. She focuses geographically on Europe.