Medication adherence is often a hurdle for glaucoma patients. To help combat this problem, a new study created tool that identified several behavior factors associated with poor compliance. The researchers suggest it could be used for personalized interventions and to optimize glaucoma drug adherence.

The study enrolled patients with poor self-reported glaucoma medication compliance and electronically monitored them for three months. At enrollment, a coordinator administered the Glaucoma Treatment Compliance Assessment Tool (GTCAT), a questionnaire based on the Health Belief Model that gathers data about cues-to-action, barriers, susceptibility, benefits, severity, patient-physician relationship, health status, depression and self-reported adherence. The participants were from the Support, Educate, Empower (SEE) personalized glaucoma coaching program pilot study at the University of Michigan Kellogg Eye Center. All subjects had a diagnosis of either glaucoma, glaucoma suspect or ocular hypertension.

The researchers also considered socioeconomic factors, health insurance status and best-corrected visual acuity.

Of the total study participants, 51 (54.3%) were white, 33 (35.1%) were Black, eight (8.5%) were Asian and two (2.1%) were unknown or other.

The GTCAT identified multiple statements with low scores. For example, only 54% of participants answered the first question, “My personal knowledge of the symptoms of glaucoma is excellent,” suggesting patients would benefit from better glaucoma education, the researchers noted.

 While more than 88% of study subjects agreed with the GTCAT statement, “Sometimes I forget to use my eye drops,” less than 32% agreed with the statement, “I use reminders to take my eye drop medications.” In the latter group, the investigators suggest it might be useful to problem solve with the patient and encourage reminders.

Additionally, only 50% of the respondents agreed with the statement, “My eye drops cause me no pain or discomfort,” a side effect could be better addressed by the care team, the researcher say. Similarly, more than 20% of subjects agreed with the statement, “My eye drops are difficult to use.” Overall, GTCAT found more than 68% of participants did not use medication reminders and overall, more than 40% reported difficulty using eye drops.

The overall adherence rate was 73.8%. The tool also showed that better adherence was linked with increased knowledge, increased cues-to-action, decreased barriers, less depression and increased self-efficacy.

The researchers noted their analysis tool identified more than 50% of patients who wanted more education about glaucoma.

Clinicians and researchers could use this tool to identify specific barriers to adherence and develop potential interventions to improve adherence, the researchers noted.

Sanchez FG, Mansberger SL, Newman-Casey PA. Predicting adherence with the glaucoma treatment compliance assessment tool. J Glaucoma. July 29, 2020. [Epub ahead of print].