EyeWorld Asia-Pacific March 2016 Issue

March 2016 Glaucoma treatment 26 EWAP SECONDARY FEATURE EyeDrops app screen showing user it’s almost time to take a drop Source: Thomas Harbin, MD Non-adherence in glaucoma therapy by Ellen Stodola EyeWorld Staff Writer Experts discuss how to identify those patients who are not adherent and how to handle them N on-adherence is a serious issue to consider in glaucoma therapy. It’s estimated that around half of patients using eye drops are not adherent or not using them as directed. Not only do physicians need to be able to address the issue, but they also need to be able to identify and even predict which patients may be facing this problem. Thomas Harbin, MD , Eye Consultants of Atlanta, Atlanta; Robert Feldman, MD , Distinguished University professor and chairman, Ruiz Department of Ophthalmology & Visual Science, UTHealth, Houston; and Michael Boland , MD , PhD , associate professor of ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, discussed how they handle this issue in their patients. AT A GLANCE • It’s estimated that around 50% of patients are non-adherent with their glaucoma therapy. • A variety of patient types may be non-adherent. This problem persists in both younger and older patients, those with worse health status, and people who have been on glaucoma treatment for less time, among other factors. • Missed appointments are a warning sign that a patient may not be taking their medication. Another sign is if the pressure is not controlled when the physician thinks it should be. The problem Obviously, non-adherence is a huge problem, Dr. Feldman said, “with about half of patients not taking their medications or not taking them as directed.” Identifying these patients is a challenge, and there are a variety of ways to approach non-adherence to medical therapy. Dr. Harbin thinks that adherence in glaucoma patients is definitely a problem. There are no great incentives to use drops to relieve pain, he said. They are also a hassle to put in and require a lifelong commitment to the treatment. Although the therapy has usually been sufficiently explained, it’s still a struggle. Dr. Harbin said that most of his patients do become adherent over time, but this is not necessarily an easy feat. Features of a patient who is non-adherent There are a variety of patient types that can fall into this category. These could include young people, Dr. Harbin said, who sometimes think that they are invincible. However, he added that non-adherence is usually seen in older patients. There are also people for whom the expense could be a problem, he said. In studies he has worked on, Dr. Boland and colleagues were able to determine some of the predictors of non-adherence. “We found some of these predictors to include younger patients, patients who are African American, those with worse health status, people who have been on glaucoma treatment for less time, and people who admitted decreased adherence,” he said. There are different kinds of non-adherent patients, Dr. Feldman said. There are those who don’t take their medications at all, and these are relatively easy to identify since the physician likely won’t see any of the typical side effects with the drops, and the patients also tend to not show up for appointments. The patients who are more difficult to diagnose are those who take medications intermittently. It’s OK to miss a few doses, but Dr. Feldman said the issue is that he needs to be able to identify what regimen they are on in order to help them. Sometimes a patient has taken his or her drops right before coming into the office, so the pressure will be somewhat controlled and the physician may see some side effects of the drops, he said. When they are not controlled on a medication, you have to figure out what they’re actually doing. Determining which patients are non-adherent One of the easiest ways to tell that a patient is not adherent with their therapy is when they start to miss appointments, Dr. Harbin said. Missed visits and not taking drops properly often go hand-in-hand, he said. Another key factor is if the pressure is not controlled when you think it should be, he said. “It’s amazing how much you have to hound patients for key details of what they’re doing.” Each time a patient comes in for an appointment, try to have him or her bring in the medication, he added. This will help the physician to see if the drops are being used. “We spend a lot of time making sure that they’re taking what we