Adherence and persistence with glaucoma therapy.

Greater Baltimore Medical Center, Baltimore, Maryland 21204, USA.
Survey of Ophthalmology (Impact Factor: 2.86). 11/2008; 53 Suppl1:S57-68. DOI: 10.1016/j.survophthal.2008.08.002
Source: PubMed

ABSTRACT Adherence and persistence with chronic therapies is crucial to prevent disease progression, such as in glaucoma. Patients report high rates of adherence, which are not supported by pharmacy claims analysis. This article reviews the literature regarding methods to assess adherence and persistence and the patient behaviors that pose challenges to proper treatment. Rates for persistence are generally below 50% at 1 year. Differentiating efficacy of eyedrops from lack of adherence presently confounds ophthalmic treatment. Additionally, as intraocular pressure (IOP) can appear controlled by short-term adherence, the physician can be fooled into believing the patient's glaucoma is well-controlled. Likewise, when progressive worsening is noted despite good IOP control, it can be problematic whether the patient's target pressure needs to be lowered or adherence needs to be improved. White-coat adherence is common, in which patient adherence rises sharply 1 week before the appointment with the physician, then declines rapidly following the appointment. White-coat adherence may make it difficult to assess IOP control over the longer term; cycling behavior with medication use is well-documented. Adherence and persistence rates differ by class of drug, with higher rates associated with prostaglandin use. We review findings from The Glaucoma Adherence and Persistency Study that identified behaviors associated with poor adherence. Greater physician awareness of adherence and persistence issues is necessary in order to help the patient become more adherent.

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    ABSTRACT: Abstract Objective: To evaluate eye drop administration by patients at multiple visits in the setting of a randomized controlled trial. Study design and methods: Patients with glaucoma or ocular hypertension were randomized to 12 weeks of treatment with topical ocular hypotensive medication in a multicenter, investigator-masked trial. At baseline, patients were given a questionnaire for self-assessment of difficulty with drop administration. At baseline and 12 weeks, patients demonstrated drop instillation using a bottle of artificial tears. Main outcome measures: Patient self-assessment of difficulty with drop administration and observed patient difficulty with drop administration, defined as bottle touching eye/adnexa, drop missing the ocular surface, or administering more than 1 drop. Results: Of 164 enrolled patients, 50% had previously been treated with ocular hypotensive medication for ≥3 years. Only 11.4% of patients reported difficulty with eye drop administration at study entry. At baseline, 18.2% of patients touched their eye/adnexa with the bottle and 10.3% missed the eye. At 12 weeks, 18.5% and 8.6% of patients, respectively, had similar difficulties. Overall, difficulty with drop instillation was observed in 42.1% of patients. Difficulty at both visits was seen in 35.3% of patients who reported difficulty at entry and in 17.2% of patients who denied difficulty. The relative risk of demonstrating difficulty at either visit was 2.0 times greater for patients who self-reported difficulty at study entry (P = 0.004). The relative risk of demonstrating difficulty at week 12 was 3.8 times greater for patients with observed difficulty at baseline (P < 0.001). Limitations of the study design included self-administration of drops to the eye of the patient's choice and observation in an office setting. Conclusions: Patients with experience instilling topical glaucoma medications continue to have difficulties with eye drop administration, including patients who do not self-report difficulty. The risk of difficulty with eye drop administration is increased in patients who self-report difficulty and in patients who have been previously observed to have difficulty. Clinical trial registry number: NCT01253902.
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    ABSTRACT: The human eye is a unique and intricate structure which has made drug delivery to the eye a formidable undertaking. Anterior-segment eye diseases are ubiquitous, especially among elderly patients, and conventional eye drops, although a first-choice dosage form, are not always an efficient treatment option. The development of novel drug delivery systems for improved treatment is therefore imperative. In an attempt to circumvent the obstacles presented by the structure of the eye, advanced systems such as ocular mini-tablets have been developed. In this review, a concerted effort has been made to provide a detailed overview of topically administered ocular mini-tablets and other solid devices for drug delivery to the anterior segment of the eye. These mini-tablets have been shown in vitro and in vivo to have significant advantages in comparison with liquid preparations. This is a step toward attaining better patient convenience and compliance, which are critical factors. Solid ophthalmic dosage forms have several advantages that can contribute to assisting with patient compliance and, ultimately, effective disease treatment. In addition to the challenges associated with topical ocular drug delivery, the shortcomings of conventional eye drops, advantages of mini-tablets, and improvements to date to these systems are discussed. The requirement for further advancements in the ocular field is also emphasized.
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