Compliance and persistency foundation for effective therapy

San Francisco - Compliance and persistency with IOP-lowering medications are difficult to assess but important to address because they affect treatment results, said Donald L. Budenz, MD, MPH, associate professor, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.

Substantial evidence exists to show noncompliance is a real problem in glaucoma both with respect to failure to keep scheduled appointments and to take medications as prescribed. While persistency is a relatively new area of research in ophthalmology, there are also studies to show that both primary open-angle glaucoma and ocular hypertension are associated with poor persistency as measured by prescription refill rates over time.

To maximize compliance and persistence, Dr. Budenz advocated patient education along with use of prescribing regimens that are simple, convenient, and well tolerated. Improving compliance and adherence with medical therapy starts with patient counseling when the diagnosis is made but needs to continue at each visit with reminders that glaucoma is a lifelong disease needing lifelong treatment to prevent blindness.

“Too often patients follow the infectious disease model of treatment and stop taking their medication when the bottle runs out,” Dr. Budenz said.

The challenge to the physician is to differentiate whether uncontrolled IOP is due to lack of medication efficacy, fluctuations in diurnal pressure, or failure to use the medication as directed. If noncompliance or lack of persistence is identified, the next challenge is to identify a strategy for overcoming those problems.

 “In an interesting study where 48 patients with glaucoma were asked why they did not take their medications as directed, 71 unique obstacles to compliance were reported. That means there will be no simple solutions for us to use to improve patient compliance but rather our approach needs to be individualized,” he said.