Glaucoma therapy patients often do not comply with their doctor’s prescribed medicine regimen

May 2 2005

A study that appears in the May edition of Ophthalmology, the clinical journal of the American Academy of Ophthalmology, shows that as many as 47 percent of patients receiving glaucoma therapy do not comply with their doctor’s prescribed medicine regimen. This is in startling contrast to the 90 percent of doctors who believe that their patients are following the prescribed treatment.

“Non-adherence to the glaucoma therapy is probably what causes patients to go blind,” said Alan L. Robin, M.D., author of the study and Academy member. “Cost of medications, multiple medications, confusing instructions all contribute to a patient’s non-compliance to their therapy.”

Dr. Robin refers to a 2003 Harris poll that illustrates this emerging health concern:

• One-third of patients surveyed took their medications less often than directed
• One-quarter delayed refilling prescriptions
• One-fifth failed to fill prescriptions
• One-fifth stopped taking a medication sooner than prescribed

The World Health Organization (WHO) estimates that worldwide, fifty percent of patients take medications improperly, at a global cost of more than $100 billion in resulting hospital admissions and lost productivity.

Dr. Robin’s study compares medication refill rates for two groups of glaucoma patients. The first group takes a single medication for one year without needing a second medication to control intraocular pressure. The second group takes the same single glaucoma medication for one year, but then a second glaucoma medication is added for an additional year. As soon as a second medication is added, approximately one-half of the second group delayed refilling prescriptions of the first medication by 5 days or more, and 22 percent waited an additional 15 days or more to pick up their pills.

“Non-compliance is a bigger problem then we imagined, and glaucoma therapy is only the tip of the iceberg,” added Dr. Robin. “It becomes a life-and-death situation for doctors to educate and motivate their patients on their therapy and with glaucoma; this may lead to visual disability and blindness.”

Dr. Robin’s study suggests that eye diseases including glaucoma are one of the five conditions at the bottom of the medical condition adherence list. The four other ailments include renal and pulmonary diseases, diabetes, and sleep disorders.

Dr. Robin is an associate professor at both the Johns Hopkins University Schools of Medicine and Public Health.