Patients must accept responsibility for their visual health, surgeon says

NEW YORK — Physicians should empower glaucoma patients to take care of their own visual health, according to one surgeon speaking here. Getting the patient involved may help improve compliance, he said.

“You need to link compliance to their core values,” said Richard P. Wilson, MD, who delivered a keynote address here at the Ocular Surgery News Symposium on Cataract, Glaucoma and Refractive Surgery. “You need to tell the patient that if they take their drops, then they will be able to pick up their grandchildren after school, so their son or daughter can go to work.”

Noncompliance with medical treatment is perhaps the biggest challenge in glaucoma patient management, Dr. Wilson noted.

As an example of how noncompliance with treatment can be a serious impediment to visual health, Dr. Wilson cited the results of a patient survey. The research showed that 25% to 40% of patients who turned in a glaucoma prescription at a pharmacy never picked up the medication. Further, among patients who started taking a prostaglandin for the first time, only 40% finished the year taking the medication. As few as 24% of patients started on other medications complied for the full year. In patients already on other glaucoma medications, only 64% finished the year taking a prostaglandin, and less than half (44%) complied with their dosing regimen for other medications.

Dr. Wilson explained that prescribing more powerful medications and increasing the use of topical combination therapy will provide better control with fewer drops, which will increase quality of life and improve compliance.

He added that the physician should spend more time counseling patients on general health issues such as exercise and smoking cessation.