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Dry eye, PTSD, anxiety in glaucoma associated with decreased compliance
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Researchers encourage identifying and treating underlying ocular surface disease and anxiety disorders to increase adherence to glaucoma treatment.
Seventy-four U.S. veterans with glaucoma filled out a 63-question survey regarding dry eye symptoms, concurrent systemic disease and medications.
Fifty-nine patients (80%) reported compliance with glaucoma therapy and made up the complaint group. Compliance was defined as missing the medication less than 25% of the time, and missing 25% or more of the scheduled drops was considered “noncompliance.”
Researchers utilized the Dry Eye Questionnaire 5 (DEQ5) to confirm the presence and severity of ocular surface symptoms.
The population primarily consisted of males, and demographic factors such as gender, race and ethnicity were not found to affect compliance.
Twenty-nine patients (39%) reported mild or greater dry eye symptoms. These patients had reduced compliance with glaucoma medications compared with those without symptoms, researchers wrote. Seventeen patients (63%) with dry eye symptoms were compliant with medications vs. 89% of patients with no dry eye symptoms.
Researchers found no relationship between the total number of medications prescribed and compliance. The mean number of glaucoma medications in the patient population was 2.0, and the average number of systemic medications prescribed was 8.8.
Patients who claimed post-traumatic stress disorder (PTSD) and anxiety were more likely to complain of dry eye symptoms, researchers wrote.
Fifty-eight percent of patients with PTSD and 57% with anxiety complained of mild or greater dry eye symptoms, compared to 34% and 32% without PTSD or anxiety, respectively, according to researchers.
Patients receiving assistance using their drops had similar compliance to those who self-administered drops.
Forgetfulness was the most common factor mentioned as a barrier to compliance in this population but was not found to be associated with noncompliance.
Researchers stressed the importance of discussing treatment compliance with patients and collaboration with other medical providers, including mental health workers. – by Abigail Sutton
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
Drugs don't work for patients who don’t take them.
This statement articulates one of the biggest challenges and most common reasons for failure in glaucoma management: poor adherence to treatment of an initially asymptomatic chronic disease.
In identifying dry eye symptoms and PTSD, Stringham and colleagues add to our understanding of, and challenge us to recognize (and address) barriers to adherence, including:
--cost (use generic medications when appropriate);
--difficulty instilling drops (instruction, use dosing aids and/or alternate delivery systems);
--adverse effects (use non-preserved or non-BAK preparations);
--inconvenience (simplify dosing, leverage fixed combinations);
--fear/misunderstanding (educate, encourage and engage the patient as part of a team); and
--forgetfulness (establish routines around activities of daily living).
The use of SLT at any point in the treatment paradigm merits consideration, as it may simultaneously address more than one of these barriers.
With persistence (continuous use) and adherence (correct use) rates hovering at only 50%, this is a big deal. Effective intervention must do more than just lower IOP; it must enhance quality of life. To that end, clinicians must treat the patient, not the pressure, recognizing and tailoring management philosophy in light of the barriers unique to each individual.
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