A 2-hour Information Session and Patient Recall has Minimal Impact on Glaucoma-treatment Persistence in a Mature Practice

Aiding Adherence to Glaucoma Medications: A Systematic Review

PURPOSE

To provide a comprehensive assessment of the strategies studied to date that focus on improving glaucoma medication adherence.

METHODS

A systematic review of the literature was conducted in MEDLINE (PubMed), Embase (Elsevier), and Scopus (Elsevier) from inception to March 1, 2021, of publications describing a device or strategy used to improve glaucoma medication adherence.

RESULTS

42 studies described by 50 papers were included. Five categories were identified: reminder systems, medication simplifications, behavioral change programs, education, and alternative engagement strategies.

CONCLUSION

Most studies (40 of the 42) addressed the question of improved adherence directly, with 26 finding improved adherence. Notably, 14 examined the clinical effects of the intervention, either in terms of intraocular pressure (IOP) or visual fields. Only three found an improvement in IOP. None demonstrated a between group difference in visual field progression.

Knowledge of Glaucoma Among Patients Attending Virtual and Face-to-Face Glaucoma Clinics

PRECIS

No significant difference in knowledge of glaucoma was found among patients attending virtual and face-to-face glaucoma clinics. Gaps in knowledge were identified in both groups highlighting the importance of incorporating patient education into glaucoma services.

PURPOSE

To examine knowledge of glaucoma among patients attending virtual compared with face-to-face glaucoma clinics.

MATERIALS AND METHODS

A survey was conducted of 105 patients with glaucoma, including 50 attending virtual and 55 attending face-to-face clinics. Participants were asked to complete a glaucoma knowledge assessment using the National Eye Health Education Program Eye-Q test. All participants had a comprehensive eye examination and completed standard automated perimetry. Knowledge of glaucoma was compared between groups and the effect of potential confounders, including age, sex, education level, and standard automated perimetry mean deviation, was explored using regression analyses. The relationship between test scores and self-perception of knowledge of glaucoma was also examined.

RESULTS

There was no significant difference between knowledge scores between patients attending virtual and face-to-face clinics with mean scores of 5.6±1.0 and 6.0±1.6 (P=0.762) respectively. More patients attending the virtual clinic could correctly identify the type of glaucoma they had (74% vs. 52.7%, P=0.005). Regression analyses found education level and patients' correct knowledge of their type of glaucoma were significantly associated with Eye-Q scores. Patients with university qualifications scored significantly higher than those with no or basic school qualifications (P=0.003) and higher-level school qualifications (P=0.038). Most patients desired to know more about their condition.

CONCLUSIONS

Patients attending virtual glaucoma clinics demonstrated similar knowledge of glaucoma compared with those attending face-to-face clinics but gaps in knowledge were identified in both groups. Patient education should be incorporated into the design of all glaucoma services.

Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence: an update in 2015

PURPOSE

To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma medication adherence.

METHODS

A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma medication adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma medication adherence, and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015.

RESULTS

Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma medication adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size..

CONCLUSION

The interventions that successfully improved glaucoma medication adherence used an adequate dose of face-to-face counseling to overcome barriers to health behavior change alongside education about glaucoma.

Systematic review of educational interventions to improve glaucoma medication adherence

Adherence to prescribed glaucoma medications is often poor, and proper adherence can be challenging for patients. We systematically reviewed the literature and identified eight studies using educational interventions to improve glaucoma medication adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in medication adherence, and two additional studies found a trend towards improvement. Using information from this systematic review and Health Behavior Theory, we constructed a conceptual framework to illustrate how counseling and education can improve glaucoma medication adherence. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed.

A study to assess the feasibility of undertaking a randomized controlled trial of adherence with eye drops in glaucoma patients

BACKGROUND

Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals. This feasibility study evaluated the measures to be used for a future randomized controlled trial assessing the effects of group-based education on adherence with eye drops.

METHODS

People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of England were recruited. A two-session education program delivered one week apart had been devised as part of a previous project. A combined adult learning and health needs approach to education was taken. Outcomes measured were knowledge of glaucoma, self-report of adherence, illness perception, beliefs about medicines, patient enablement, and general health (Short Form-12). Adherence was also measured objectively using a Medical Events Monitoring System device.

RESULTS

Twenty-six participants consented to undertake the educational program and 19 produced analyzable data. Knowledge of glaucoma, illness perception, beliefs about medicine, and patient enablement all showed statistically significant improvements after education. Mean adherence with eye drops was maintained above 85% before and for 3 months after attendance at the educational program. Self-report exaggerated adherence by at least 10% when compared with the objective Medical Events Monitoring System data, and in fact the kappa agreement was zero.

CONCLUSION

All questionnaires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops. A multicenter, randomized, controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step.