Article Date: 8/1/2006

Improving Patient Compliance For Better Visual Outcomes

Understanding the barriers to compliance will help you develop new strategies that will lead to improved patient care.
By Judith Springer Riddle, Senior Editor

Ensuring your glaucoma patients take IOP-lowering drugs as directed remains an uphill battle. You'd like to assume your patients are taking their medications faithfully, but many are not.

Although patient compliance to medical therapy has improved somewhat, research shows only 75% of patients take ocular medications as prescribed.1

A recent study by Shah found that 77% of patients with open-angle glaucoma claimed to be fully compliant; only 23% said they didn't take their medications consistently.2 But as doctors know from experience, self-reporting is often inaccurate.

Adherence to glaucoma therapy is even less likely when patients must use more than one medication, which is often the case.

In a study by Patel and Spaeth,3 patients who used only one glaucoma drug were 50% more adherent to medical therapy compared with one-third of patients who used multiple drugs.

Consequences of poor compliance

When patients don't take their medications as prescribed, the quality of care becomes compromised. If you do not know exactly how patients are taking their medications, you can't make critical decisions about dosing adjustments, adjunctive therapies or alternate treatment modalities.4

Noncompliant patients are more likely to have uncontrolled IOPs and risk irreversible visual-field loss.

What's more, noncompliance leads to higher out-of-pocket healthcare costs for patients when doctors have to prescribe additional drugs and order invasive surgical procedures, such as
trabeculoplasty or filtration surgery, to slow disease progression.

Knocking down the barriers

Why don't patients take their glaucoma medications as prescribed? Some say they choose to use the drugs occasionally to avoid side effects.2

Others skip their medications altogether because they find it difficult to keep up with dosing schedules and to instill drops in their eyes. Forgetfulness is the primary cause of patient noncompliance.3 Other issues include lack of patient education about the disease and poor understanding of the consequences of not taking glaucoma drugs.

Improving the odds

Whatever reasons patients give for medical noncompliance, you can take a proactive approach to improve adherence, starting with communication. For instance, asking open-ended questions will help you find out how patients are using their medications. But be mindful of how you ask these questions. Asking, "Are you taking your medications?" may sound intimidating to some patients and will only give you "yes" or "no" answers that may or may not be truthful. Encouraging patients to "Tell me how you're using your medications" will spark a discussion between you and your patients and reveal how much they know about glaucoma.

If they don't know enough, you can use that opportunity to discuss the disease process, the rationale behind the treatment
regimens and why they're critical to preventing vision loss.

What's more, you can empathize with patients' concerns about side effects and dosing schedules by choosing drugs that are easier for them to use and by tailoring treatment regimens that fit their special needs and limitations.

By using these and other methods to improve communication, you should continue to see a gradual increase in medical therapy compliance and much better visual outcomes.

What's next? New study results and their clinical applications, which also should improve patient compliance and help doctors better manage glaucoma.


1. DiMatteo RM. Variations in Patients' Adherence to Medical Recommendations: A Quantitative Review of 50 Years of Research. Medical Care. 2004;42:200-209.

2. Deokule S., Sadiq S., Shah S. Chronic open angle glaucoma: patient awareness of the nature of the disease, topical medication, compliance and the prevalence of systemic symptoms. Ophthal Physiol Opt 2004;24:9-15.

3. Patel, SC, Spaeth, GL. Compliance in patients prescribed eye drops for glaucoma. Ophthalmic Surg. 1995;26:233-236.

4. Shaya, FT. Compliance with Medicine. Ophthalmol Clin N Am. 2005;18:611-617.

Optometric Management, Issue: August 2006