Improving Adherence to Topical Medication in Patients with Glaucoma

Ian Tapply,1,2 David C Broadway1,3 1Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK; 2Department of Ophthalmology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK; 3School of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, UKCorrespondence: Ian TapplyDepartment of Ophthalmology, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UKTel +44 7810 583319Email ian.tapply@nhs.netAbstract: The glaucomas form a heterogenous group of conditions, which collectively account for one of the most common irreversible causes of blindness worldwide. The only treatment, for which there is evidence, to stop or slow glaucomatous disease progression is to lower intraocular pressure (IOP); this is most often initially achieved with topical medication. Adherence to anti-glaucoma therapy is known to be low even when compared with adherence to therapy for other chronic conditions. We performed a PubMed search to review evidence as to how adherence to and persistence with anti-glaucoma medications might be improved. Approaches to improving adherence include technological (such as using smart drop bottles or automated reminders) use of instillation aids, improving communication with patient education and improving tolerability of eye drop formulations. There is limited short-term evidence that automated reminders can be effective and, unfortunately, instillation aids have not proved to be efficacious with respect to improving adherence. A range of factors have been identified which affect adherence and persistence, although only a multi-faceted approach has proven evidence of efficacy, compared to improved patient education alone. There is now a wider range of available preservative-free eye drops, which have been shown to be non-inferior in achieving IOP control, with fewer side effects and improved short-term adherence. Further studies relating to adherence are warranted, particularly given the projected increase in glaucoma prevalence worldwide.Keywords: tolerability, ocular hypotensives, interventions, persistence, intraocular pressur