Failure to Use Glaucoma Medication Linked to Demographic Factors Risk Factors for Poor Adherence to Eyedrops in Electronically Monitored Patients With Glaucoma

Objective: To identify factors associated with non-adherence to glaucoma medication use. Design: Prospective, observational cohort study. Participants: 196 patients with primary open angle glaucoma or ocular hypertension were recruited from two academic institutions for participation in this study. Methods: Patients were managed with topical prostaglandin therapy and were instructed at enrollment in usage of the Travatan Dosing Aid, an electronic monitoring device that allows timing and frequency determination when using Travatan eyedrops. Patients were given free medication during the 3-month study. Patients underwent baseline testing, which included clinical examination as well as questionnaires assessing socio-demographic information, mental health status, and overall health status. In addition, patients completed a questionnaire assessing their overall knowledge of glaucoma therapy and its goals. Statistical analysis was performed to determine factors associated with non-adherence to glaucoma medication use. Non-adherence was defined by failure to use their dose within 4 hours of the scheduled dosage time ≥75% of the time. Results: Multivariate statistical analysis allowed identification of independent predictors of non-adherence. These factors included age <50 or >80 years, African-American race, and an overall lower level of health status. A lower level of education and socioeconomic status were also associated with a higher likelihood of non-adherence. Patients who expressed a poor understanding of the goals of glaucoma therapy were more likely to be non-adherent. Conclusions: Age, socioeconomic status, African-American race, and a lower level of overall health status are important risk factors for non-adherence to glaucoma medication use. Reviewer's Comments: It was also found that patients, when asked in a non-confrontational manner, were fairly willing to admit to non-adherence to glaucoma medication use. Having an understanding of risk factors for non-adherence and how to bring up the subject with patients in a manner that will put them at ease and not make them feel embarrassed or ashamed about their failure to completely follow recommended therapy will assist in identifying individuals who need intervention in the form of patient education thus allowing them to gain benefits from glaucoma medication use. (Reviewer-Scott D. Smith, MD, MPH).