Pushing the Adherence Rock Up the Hill

Christopher Glenn, Editor in Chief

With the return of the annual Glaucoma Issue comes the unwelcome challenge of opening that issue with something definitive to say about the state of the disease and its treatment. I’ve swung and missed on about a dozen of those annual challenges so far, so you’d think I’d learn.

All of the usual treatment challenges remain and, as regularly happens, are reinforced by ever-growing bodies of data. Most recently, two studies from JAMA Ophthalmology.

One described an effort at the Wilmer Eye Institute to electronically monitor hundreds of patients over three months for their adherence to prostaglandin therapy. Results were expectedly spotty. About 80 percent of patients reported using their meds  three-quarters of the time. Most of the remainder were deemed nonadherent, and were less likely to be able to name their glaucoma medication, less likely to agree that remembering to use the medication was easy, and more likely to agree with the sentiment that eye drops can cause problems.

A second study by the same researchers looked at the effectiveness of voice or text messages as an intervention to improve adherence. The patients deemed non-adherent in the first study were randomized to an intervention (daily messages, either text or voice, reminding patients to use their glaucoma medication) or no intervention. The median adherence rate in the intervention group increased from 53 percent to 64 percent. There was no change in the controls. Patients in the intervention agreed the reminders were helpful and that they would continue to use them outside the study. Implementing the intervention was estimated to cost about $20 per year per patient.

The sad state of glaucoma drug adherence seems to just go on and on. Any effort to push closer to solutions is worthy and this is in no way meant to detract from this work but if you substitute fax for text message,  studies with results much like these might have easily been published in 2002. Perhaps the more widespread availability of today’s handheld technology will make a dent where old media couldn’t. Or there’s another approach.

Microincision glaucoma surgeries have been on the scene for a couple of years now. At the outset they may have suffered the expected resistance or at least suspicion that accompanies any glaucoma surgery in the presence of an “effective” medical option like the prostaglandins. But the past few years have given surgeons the time to test some of these procedures. Even if you are skeptical, especially if you are skeptical, I invite you to take in the experience of the early users and see whether one of these procedures has a place in your practice.

Or you can wait for next year’s adherence reports.