Visual field progression continued even with better medication adherence in this study.

Visual field progression continued even with better medication adherence in this study. Photo: Brian D. Fisher, OD. Click image to enlarge.

Although diligence in sticking with a prescribed treatment regimen is a problem all across of health care, medication adherence among glaucoma patients is notoriously poor, with eyedrop nonadherence rates around 80%. Studies suggest there are a number of contributing factors including cost and physical and mental limitations. Recently, a secondary analysis of a real-world clinical trial on glaucoma medication adherence among veterans reported that, despite a multi-step intervention that did improve adherence, clinical outcomes weren’t affected at 12 months.

In the parent study (NCT03052257), researchers reported greater medication adherence among the treatment group, which received a glaucoma education session with drop administration instruction and a “smart bottle” of eye drops that gave virtual reminders, compared with the control group, which received a general eye health class and a smart bottle without the reminder function. This study population consisted mainly of males, and medications were provided at low or no cost.

Researchers conducting the secondary analysis examined patients’ medical charts and defined disease progression as visual field progression or escalation of glaucoma therapy in the 12 months following randomization. This study’s outcome measure had a “pragmatic” focus, since the parent study’s sample size was aimed at capturing adherence numbers rather than clinical outcomes.

The researchers reported no difference between the intervention group (n=100) and the control group (n=100), where 36% and 32% of patients experienced disease intensification, respectively. “Twelve months may not be long enough to see the clinical effect of this intervention, or more than six months of intervention are needed,” the researchers wrote in their paper.

Buehne KL, Rosdahl JA, Hein AM, et al. How medication adherence affects disease management in veterans with glaucoma: lessons learned from a clinical trial. Ophthalmic Res. January 5, 2023. [Epub ahead of print].