April 2020


Presentation Spotlight
Increasing compliance with glaucoma patients

by Stefanie Petrou Binder, MD Contributing Writer

There is an abundance of glaucoma resources online, yet for some patients, this often amounts to too much information, leaving them more confused about their glaucoma treatment plan.1–3 It is difficult to understand the extent of non-compliance, as the numbers found in clinical research reports vary.
According to research, direct intervention resulted in positive changes to patients’ habits. “This study is to determine if grassroots efforts within our own private practice increases glaucoma self-efficacy by following constructs of the Health Belief Model,” said Nicole
Kesten, MS, first author of an e-poster presented at the 2019 ASCRS ASOA Annual Meeting.

Education from the bottom up

Ms. Kesten and her colleagues recruited 100 patients and documented how many years patients had glaucoma, the number of drops prescribed, and the extent of family involvement with care. Baseline assessments (30 questions) taken prior to the intervention evaluated the perceived susceptibility, severity, and understanding of the benefits of compliance in relation to the Health Belief Model.
The staff and doctors created YouTube videos specific to common patient issues. A new patient education tab on their website provided videos and other recommended resources, including links, drop sheet schedules, and medication app suggestions. Each patient was educated on new resources by the staff as a cue to action. After 60 days of intervention, researchers performed follow-up assessment, which was compared to baseline.

Did intervention help patients?

Ninety-two patients were provided with the education/intervention program, of which 72 completed follow-up. Average for follow-up was 33.2 days (±9.7 days), with shorter follow-up times necessary in some cases to meet the deadline.
Ms. Kesten noted several pertinent findings. “Not all patients will find benefit with patient education interventions, but small efforts can impact some,” she said. “According to exit surveys, hands-on drop instillation techniques were the most beneficial. It might be a consideration for practices to have technicians and assistants check drop instillation administration with patients as an effective adherence tool for physicians, while balancing administrative costs.”
At baseline, 45% of 64 patients who were monitored demonstrated complete instillation, while 55% had partial/incomplete instillation. All patients were given hands-on demonstration/assistance in better drop self-administration, resulting in improved drop instillation, the exit survey found. The exit survey also demonstrated that 80% who forgot to take their drops >1/week stated they made a change due to the intervention. While the at-risk groups adjusted their behaviors, 43% of those interviewed at exit did not.
When questioned about their concerns regarding glaucoma, on average, patients rated concern over susceptibility and severity at 1.39±0.55 (scored: 1–concerned, 2–neutral, or 3–not concerned). In response to the question, “I understand the consequences of uncontrolled glaucoma (i.e., permanent blindness),” the patient scores indicated a high level of awareness. When asked how concerned they were about losing vision due to glaucoma, the average patient score was 4.00±1.04 (scored: 1–not at all, 2–slightly, 3–moderately, 4–very, and 5–extremely).

Cues to action

The study’s findings suggest that a combination of approaches could improve patient compliance, such as YouTube videos discussing glaucoma/drops and teaching patients hands-on drop-administration techniques. The study also recommended showing patients how to use a phone app for medication reminders and urged eye doctors to offer to create a printable drop schedule.
It took doctors/staff 10–15 minutes per patient to perform these interventions, including the recommended cues to action.

About the source

Nicole Kesten, MS
Practice administrator
Chicago Glaucoma Consultants
Chicago, Illinois


1. Lacey J, et al. Barriers to adherence with glaucoma medications: a qualitative research study. Eye (Lond). 2009;23:924–932.
2. Robin A, Grover DS. Compliance and adherence in glaucoma management. Indian J Ophthalmol. 2011;59 Suppl:S93–96.
3. Taylor SA, et al. Causes of non-compliance with drug regimens in glaucoma patients: a qualitative study. J Ocul Pharmacol Ther. 2002;18:401–409.

Relevant disclosures

Kesten: None


Kesten: wms13@hotmail.com

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