Compliance and Adherence: Lifelong Therapy for Glaucoma

  • Alan Robin
  • Betsy Sleath
  • David Covert


The Early Manifest Glaucoma Trial randomized those with early diagnosed previously untreated glaucoma into two groups: no treatment or treatment with a combination of laser trabeculoplasty plus betaxolol ophthalmic solution. At a median follow-up of 8 years, 67% of all subjects progressed and treatment significantly decreased the rate of progression. Despite the initially optimistic news, the results are not as encouraging as they might seem. As one might imagine, 76% of the control group progressed. However, despite apparent treatment, 59% of the treated glaucoma patients also progressed. One would like to know why more than 50% of those under treatment still experience additional glaucomatous progression.


Glaucoma Patient Visual Field Loss Prostaglandin Analog Glaucoma Medication Laser Trabeculoplasty 
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  1. 1.
    Leske CM, Heijl A, Hyman L, Bengtsson B, Dong L, Yang Z, EMGT Group. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007;114:1965–1972.CrossRefPubMedGoogle Scholar
  2. 2.
    The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol. 2000;130:429–440.CrossRefGoogle Scholar
  3. 3.
    DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–209.CrossRefPubMedGoogle Scholar
  4. 4.
    Kass MA, Meltzer DW, Gordon M, et al. Compliance with topical pilocarpine treatment. Am J Ophthalmol. 1986;101:515–523.PubMedGoogle Scholar
  5. 5.
    Kass MA, Gordon M, Morley RE, et al. Compliance with topical timolol treatment. Am J Ophthalmol. 1987;103:188–193.PubMedGoogle Scholar
  6. 6.
    Tsai T, Robin AL, Smith JP III. An evaluation of how glaucoma patient use topical medications: a pilot study. Transactions of the AOS. 2007;105:29–33.Google Scholar
  7. 7.
    Stone JL, Robin AL, Sleath B, Covert DW, Cagle G, Novack GN. Compliance: An Objective Evaluation in Glaucoma Patients of Eye-Drop Instillation Using Video Instillations and Patient Surveys. Invest Opthalmol Vis Sci. 2008;49:E-Abstract 1580.Google Scholar
  8. 8.
    Brown MM, Brown GC, Spaeth GL. Improper topical self-administration of ocular medication among patients with glaucoma. Can J Ophthalmol. 1984;19:2–5.PubMedGoogle Scholar
  9. 9.
    Kass MA, Hodapp E, Gordon M, et al. Part I. Patient administration of eyedrops: interview. Ann Ophthalmol. 1982;14:775–779.PubMedGoogle Scholar
  10. 10.
    Norell SE, Granstrom PA, Wassen R. A medication monitor and fluorescein technique designed to study medication behaviour. Acta Ophthalmol (Copenh). 1980;58:459–467.CrossRefGoogle Scholar
  11. 11.
    Kass MA, Hodapp E, Gordon M, et al. Patient administration of eyedrops: observation. Part II. Ann Ophthalmol. 1982;14:889–893.PubMedGoogle Scholar
  12. 12.
    Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: A randomized trial determines that topical ocular hypotensive medicine delays or prevents the onset of POAG. Arch Ophthalmol. 2002;120(6):701–713.PubMedGoogle Scholar
  13. 13.
    The AGIS Investigators. The Advanced Glaucoma Study (AGIS):7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol. 2000;130(4):429–440.CrossRefGoogle Scholar
  14. 14.
    Lichter PR, Musch DC, Gillespie BW, et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology. 2001;108:1943–1953.CrossRefPubMedGoogle Scholar
  15. 15.
    Robin AL, Novack GD, Covert DW, et al. Adherence in glaucoma: Objective measurements of once-daily and adjunctive medication use. Am J Ophthalmol. 2007;144:533–540.CrossRefPubMedGoogle Scholar
  16. 16.
    Sleath B, Robin AL, Covert D, et al. Patient-reported behavior and problems in using glaucoma medications. Ophthamology. 2006;113(3):431–436.CrossRefGoogle Scholar
  17. 17.
    Taylor SA, Galbraith SM, Mills RP. Causes of non-compliance with drug regimens in glaucoma patients: a qualitative study. J Ocul Pharmacol Ther. 2002;18:401–409.CrossRefPubMedGoogle Scholar
  18. 18.
    Lee MD, Fechtner FR, Fiscella RG, et al. Emerging perspectives on glaucoma: highlights of a roundtable discussion. Am J Ophthalmol. 2000;130(4 suppl):S1-S11.CrossRefPubMedGoogle Scholar
  19. 19.
    Covert D, Robin AL, Novack GD. Systemic medications and glaucoma patients. Ophthalmology. 2005;112:1500–1504.CrossRefGoogle Scholar
  20. 20.
    Nordstrom BL, Friedman DS, Mozaffari E, et al. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol. 2005;140(4):598–606.PubMedGoogle Scholar
  21. 21.
    Schwartz GF, Platt R, Reardon G, et al. Accounting for restart rates in evaluating persistence with ocular hypotensives. Ophthalmology. 2007;114:648–652.CrossRefPubMedGoogle Scholar
  22. 22.
    Tsai JC, McClure CA, Ramos SE, et al. Compliance barriers in glaucoma: a systematic classification. J Glaucoma. 2003;12(5):393–398.CrossRefPubMedGoogle Scholar
  23. 23.
    Miller LG, Liu H, Hays RD, et al. How well do clinicians estimate patients’ adherence to combination antiretroviral therapy? J Gen Intern Med. 2002;17:1–11.CrossRefPubMedGoogle Scholar
  24. 24.
    Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27:1218–1224.CrossRefPubMedGoogle Scholar
  25. 25.
    Crane J. Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997;15:1–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Roter DL. The outpatient medical encounter and elderly patients. Clin Geriatr Med. 2000;16:95–107.CrossRefPubMedGoogle Scholar
  27. 27.
    Beisecker AE, Beisecker TD. Patient information-seeking behaviors when communicating with doctors. Med Care. 1990;28:19–28.CrossRefPubMedGoogle Scholar
  28. 28.
    Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996;156:1414–1420.CrossRefPubMedGoogle Scholar
  29. 29.
    Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252:2990–2994.CrossRefPubMedGoogle Scholar
  30. 30.
    Herndon LW, Brunner TM, Rollins JN. The Glaucoma Research Foundation Patient Survey: patient understanding of glaucoma and its treatment. Am J Ophthalmol. 2006;141:22–28.CrossRefGoogle Scholar
  31. 31.
    Sleath B, Byrd J, Robin AL, et al. Glaucoma patient receipt of information and instruction on how to use their eye drops. Int J Pharm Pract. 2008;16(1):35–40.CrossRefGoogle Scholar
  32. 32.
    AAO. Comprehensive Adult Medical Eye Evaluation, Preferred Practice Pattern. San Francisco: American Academy of Ophthalmology. <>; 2005.
  33. 33.
    Schwartzberg JG, Cowett A, VanGeest J, et al. Communication techniques for patients with low health literacy: a survey of physicians, nurses, and pharmacists. Am J Health Behav. 2007;31(suppl 1):S96-S104.PubMedGoogle Scholar
  34. 34.
    Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83–90.CrossRefPubMedGoogle Scholar
  35. 35.
    Golin CE, DiMatteo MR, Gelberg L. The role of patient participation in the doctor visit: implications for adherence to diabetes care. Diabetes Care. 1996;19:1153–1164.CrossRefPubMedGoogle Scholar
  36. 36.
    Street RL, Piziak VK, Carpenter WS, et al. Provider-patient communication and metabolic control. Diabetes Care. 1993;16:714–721.CrossRefPubMedGoogle Scholar
  37. 37.
    Roter DL, Hall JL. Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits. Westport, CT: Auburn House; 1992:203.Google Scholar
  38. 38.
    Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51(7): 1087–1110.CrossRefPubMedGoogle Scholar
  39. 39.
    Sleath B, Roter D, Chewning B, et al. Question-asking about medications: physician experiences and perceptions. Med Care. 1999;37(11):1169–1173.CrossRefPubMedGoogle Scholar
  40. 40.
    Sleath B, Krishnadas R, Cho M, et al. Patient-reported barriers to glaucoma medication access, use, and adherence in Southern India. Indian J Ophthalmol. 2009;57(1):63–68.CrossRefPubMedGoogle Scholar
  41. 41.
    Konstas AGP, Maskaleris G, Gratsonidis S, et al. Compliance and viewpoint of glaucoma patients in Greece. Eye. 2000;14:752–756.PubMedGoogle Scholar
  42. 42.
    Spaeth GL. Visual loss in a glaucoma clinic. I. Sociological considerations. Invest Ophthalmol. 1970;9:73–82.PubMedGoogle Scholar
  43. 43.
    Olthoff CMG, Schouten JSAG, Van de Borne BW, et al. Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension. Ophthalmology. 2005;112:953–961.CrossRefPubMedGoogle Scholar
  44. 44.
    Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120(10):1268–1279.PubMedGoogle Scholar
  45. 45.
    Collaborative Normal-Tension Glaucoma Study Group. The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Am J Ophthalmol. 1998;126(4):498–505.CrossRefGoogle Scholar
  46. 46.
    Urquhart J. Patient non-compliance with drug regimens: measurement, clinical correlates, economic impact. Eur Heart J. 1996;17(suppl A):S8-S15.Google Scholar
  47. 47.
    DuBiner HB, Sircy MD, Landry T, et al. Comparison of the diurnal ocular hypotensive efficacy of travoprost and latanoprost over a 44-hour period on patients with elevated intraocular pressure. Clin Ther. 2004;26:84–91.CrossRefPubMedGoogle Scholar
  48. 48.
    Garcia-Feijoo J, Martinez-de-la-Casa JM, Castillo A, et al. Circadian IOP-lowering efficacy of travoprost 0.004% ophthalmic solution compared to latanoprost 0.005%. Curr Med Res Opin. 2006;22:1689–1697.CrossRefPubMedGoogle Scholar
  49. 49.
    Sit AJ, Weinreb RN, Crowston JG, et al. Sustained effect of travoprost on diurnal and nocturnal intraocular pressure. Am J Ophthalmol. 2006;141:1131–1133.CrossRefPubMedGoogle Scholar
  50. 50.
    Neelakantan A, Vaishnav HD, Iyer SA, et al. Is the addition of a third or fourth antiglaucoma medication effective? J Glaucoma. 2004;13:130–136.CrossRefPubMedGoogle Scholar
  51. 51.
    Young TL, Higginbotham EJ, Zou XL, et al. Effects of topical glaucoma drugs on the fistulized rabbit conjunctiva. Ophthalmology. 1990;97:1423–1427.PubMedGoogle Scholar
  52. 52.
    Hughes D, Cowell W, Koncz T, et al. Methods for integrating medication compliance and persistence in pharmacoeconomic evaluations. Value Health. 2007;10:498–509.CrossRefPubMedGoogle Scholar
  53. 53.
    Lee PL, Walt JG, Doyle JJ, et al. A multi-center, retrospective pilot study of resource utilization and costs associated with severity of disease in glaucoma. Arch Ophthalmol. 2006;124:12–19.CrossRefPubMedGoogle Scholar
  54. 54.
    Distelhorst JS, Hughes GM. Open-angle glaucoma. Am Fam Physician. 2003;67:1937–1944.PubMedGoogle Scholar
  55. 55.
    McKean-Cowdin R, Varma R, Wu J, et al. Severity of visual field loss and health-related quality of life. Am J Ophthalmol. 2007;143:1013–1023.CrossRefPubMedGoogle Scholar
  56. 56.
    Altangerel U, Spaeth GL, Rhee DJ. Visual function, disability, and psychological impact of glaucoma. Curr Opin Ophthalmol. 2003;14:100–105.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Alan Robin
    • 1
  • Betsy Sleath
    • 2
  • David Covert
    • 3
  1. 1.International Health, Bloomberg School of Public Health, Wilmer Institute, Johns Hopkins School of MedicineBaltimoreUSA
  2. 2.University of North Carolina, School of PharmacyChapel HillUSA
  3. 3.Department of Health EconomicsAlcon Research LimitedFort WorthUSA

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