Personalized glaucoma coaching program improves treatment adherence

The personalized Support, Educate, Empower (SEE) health coaching intervention significantly improved treatment adherence among adult patients with glaucoma compared to standard written education methods, according to a recent study.¹

A team of University of Michigan investigators reported that their multimodal, chronic disease self-management support program for people living with glaucoma, SEE, was linked to an approximate 20% improvement in self-reported glaucoma patient treatment adherence from baseline compared to their control group.

Relevant to the primary outcome, the novel intervention was also associated with significant decreases in glaucoma-related distress versus the control arm — an improvement particularly driven by measures of emotional burden and regimen-related distress. Having enhanced the scalability of the SEE Program through a series of available online tools, scripts, and rubrics, the investigators are now seeking to further determine its impact on glaucoma treatment outcomes.

Paula Anne Newman-Casey, MD, MS, of the Department of Ophthalmology and Visual Sciences at the University of Michigan, and colleagues designed the SEE Program for people living with glaucoma who self-report poor adherence to their medication. It was designed with feedback from patients with glaucoma as well as motivational interviewing experts. The program is delivered by trained non-physician coaches and features personalized multimedia glaucoma education, script-supported, motivational interviewing-based coaching, medication reminders via text messaging or phone calls, and treatment adherence monitoring.

Issues with glaucoma treatment adherence

As Newman-Casey and colleagues noted, glaucoma remains the second leading cause of irreversible blindness among all Americans and the leading cause of vision loss in Black individuals despite an armamentarium of effective therapies to treat it. The amount of glaucoma cases in the US is projected to more than double by 2050, exceeding 7 million.

“Nonadherence to daily eye drop medications — the treatment for 73% of patients with glaucoma — is a key modifiable driver of vision loss in glaucoma,” investigators wrote. “Patients with glaucoma do not use eye drops as scheduled at least 40% of the time.”

Experts have often advocated for individualized treatment plans to help promote awareness among glaucoma patients and inherently help to improve their adherence to vision-preserving therapies. James Tsai, MD, MBA, chair of the Department of Ophthalmology at Mount Sinai Health System in New York, told Ophthalmology Times earlier this year that he addresses challenges to patient medication adherence directly with each individual patient and works to instill a habit-forming mindset with their treatment.²

“My advice is based on their knowledge and interest level, and this is a great pitch for individualizing the treatment plan,” Tsai said. “It is incumbent on the physician and his or her team to understand the type of information that each patient and the family need to ensure the best possible care.”

Trial methods

The parallel, nonmasked, 1:1 randomized clinical trial assessed the superiority of the SEE program versus control intervention for glaucoma medication adherence.¹

The 6-month program assessed in the trial included the following interventions for adults with poor adherence to their glaucoma treatment:

1. In-person coaching sessions at baseline, 2 months, and 4 months
2. 4 between-visit phone calls from baseline through 5 months
3. Coach-led discussions around patients’ adherence scores and barriers to self-management
4. Electronic monitoring of medication-taking behavior (via Adheretech) and dose adherence (via electronic pill bottle transmissions)

The control arm received educational materials via mail from organizations including the American Academy of Ophthalmology, the National Eye Institute, and the Glaucoma Research Foundation every 2 months. Both arms additionally received standard glaucoma care from their physicians.

Trial participants were recruited from the University of Michigan and Henry Ford Health System between April 2021 and December 2023. Eligible patients were adults with glaucoma taking ≥1 ocular hypotensive eye drop medication who self-reported adherence of ≤85% of their doses.

Study findings

Among the 236 participants enrolled across the 2 institutions, 117 were randomized to SEE and 118 were randomized to control. Mean patient age was 67.3 years old and 53% (n = 124) of patients were female. Mean-self reported treatment adherence was 63.9% at baseline.

After the 6-month intervention, investigators observed a significantly improved medication adherence among the SEE intervention arm (77.6%) versus the control arm, which decreased its adherence rate to 58.0% (difference, 19.7%; 95% CI, 13.7 – 25.6; P <.001).

The team additionally observed that more than double the patients to undergo SEE achieved ≥80% treatment adherence (n = 62 [54.9%]) versus the control arm (n = 27 [23.7%]; P <.001).

Investigators conducted a 17-item questionnaire adapted from the diabetes distress scale to interpret changes in glaucoma-related distress from baseline to the end of assessment. They found SEE intervention participants reported greater decreases in disease-related distress — a mean change of 0.6 points in scoring versus 0.2 among the control arm.

Newman-Casey and colleagues concluded that their personalized treatment coaching program provided significant improvements to glaucoma medication adherence and reductions in clinically relevant distress compared to standard written education.

“To enhance scalability, the SEE Program was created with a web-based tool that creates personalized glaucoma education, a script to guide motivational interviewing-based coaching sessions, a glaucoma-specific motivational interviewing-based training program for health educators, and a rubric to grade fidelity to the intervention,” they wrote. “We now plan to evaluate the SEE Program in a pragmatic implementation trial that examines impacts on biological outcomes as well as implementation process measures.”

References

1. ^{Newman-Casey PA, Niziol LM, Lu M, et al. Effect of the Support, Educate, Empower Personalized Glaucoma Coaching Program on Medication Adherence: The SEE Program Randomized Clinical Trial. JAMA Ophthalmol. Published online February 26, 2026. doi:10.1001/jamaophthalmol.2026.0001}
2. ^{Tsai TC, Charters L. Why individualized glaucoma care remains essential amid uneven patient awareness. Ophthalmology Times. Published January 22, 2026. https://www.ophthalmologytimes.com/view/why-individualized-glaucoma-care-remains-essential-amid-uneven-patient-awareness}