November 2015




ASCRS Clinical Survey

Glaucoma medication compliance

by EyeWorld staff

ASCRS Clinical Survey logo

Medication compliance diagram

Figure 1

Diagram of medication non-compliance Figure 2 Source: ASCRS

Patient non-compliance is one of the main reasons that medications fail to control intraocular pressure in glaucoma patients. As the number of medications that a patient is prescribed goes up, compliance rates go down.

In the 2015 ASCRS Clinical Survey, ASCRS members were surveyed about medication compliance in their glaucoma patients. When asked what percentage of their glaucoma patients (who are prescribed one medication) are non-compliant, on average, respondents said that they believe that 31% of their patients are non-compliant. Additionally, 12% believe that 60% or more of their patients are non-compliant. U.S. ophthalmologists responded, on average, that 33% of their patients are non-compliant, while non-U.S. ophthalmologists said that 29% of their glaucoma patients are non-compliant (see Figure 1).

Ophthalmologists were also asked what they thought the non-compliance rate was among patients who were prescribed more than one medication. On average, survey respondents believed that 38% of their patients who are prescribed multiple glaucoma medications are non-compliant, and 19% of respondents believed that 60% of their patients are non-compliant. U.S. ophthalmologists believed that 42% of their patients who are prescribed multiple medications are non-compliant, compared to non-U.S. doctors who said that 33% of their patients are non-compliant (see Figure 2).

Rick Lewis, MD, in practice in Sacramento, Calif., said he is surprised by how low the numbers are. Most studies suggest non-compliance rates of 50% independent of the medication, administration, ethnicity, etc. Chronic application of topical eye drops is very difficult for patients.

It has been proven that doctors are unable to predict rates of compliance in their patients, but generally they think that their patients are more compliant [than they actually are]. The good news about compliance in some of our glaucoma drops has to do with the long duration of action of the prostaglandins, he said.

He noted that there are some pearls for improving compliance rates in a practice. Talk to your patientsexplain the disease and the natural history of their condition and discuss how therapy will impact the predicted/expected outcomes. Then prescribe a simple, easy, and minimally expensive way for them to comply. New therapies are focusing on improved drug delivery systems to take compliance out of patients hands. This includes intracameral and subconjunctival delivery systems, punctal plugs, and conjunctival rings. Intracameral or intravitreal administration takes compliance away from the patient and brings it to the doctor, which would solve the compliance issue, he said.

Editors note: Dr. Lewis has financial interests with Alcon (Fort Worth, Texas), Aerie Pharmaceuticals (Irvine, Calif.), Allergan (Dublin, Ireland), and Envisia (Research Triangle Park, N.C.).

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