References

 1. Schoff EO, Hattenhauer MG, Ing HH, et al. (2001) Estimated incidence of open-angle glaucoma in Olmsted County, Minnesota. Ophthalmology 108(5):882–6.

 2. Mason RP, Kosoko O, Wilson MR, et al. (1989) National survey of the prevalence and risk factors of glaucoma in St. Lucia, West Indies. Part I. Prevalence findings. Ophthalmology 96(9):1363–8.

 3. Wilson MR, Kosoko O, Cowan CL Jr, Crandall D, et al. (2002) Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia, West Indies. Am J Ophthalmol 134(3):399–405.

 4. Collaborative Normal Tension Glaucoma Study Group (1998) Comparison of glaucomatous progression between untreated patients with normal tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol 126:487–97.

 5. Leske MC, Heijl A, Hyman L, et al. (1999) Early Manifest Glaucoma Trial: Design and baseline data. Ophthalmology 106:2144–53.

 6. Heijl A, Leske MC, Bengtsson B, et al.; For the Early Manifest Glaucoma Trial Group (2002) Reduction of intraocular pressure and glaucoma progression: Results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 120:1268–79.

 7. Kass MA, Heuer DK, Higginbotham EJ, et al. (2002) The Ocular Hypertension Treatment Study: A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 120(6):701–13; discussion 829–30.

 8. Miglior S, Zeyen T, Pfeiffer N, et al.; European Glaucoma Prevention Study (EGPS) Group (2002) Results of the European Glaucoma Prevention Study. Ophthalmology 112(3): 366–75.

 9. Miglior S, Pfeiffer N, Torri V, et al.; European Glaucoma Prevention Study (EGPS) Group (2007) Predictive factors for open-angle glaucoma among patients with ocular hypertension in the European Glaucoma Prevention Study. Ophthalmology

114(1):3–9.

10.Hattenhauer MG, Johnson DH, Ing HH, et al. (1998) The probability of blindness from open-angle glaucoma. Ophthalmology 105(11):2099–104.

11.Anderson DR, Drance SM, Schulzer M; Collaborative Normal-Tension Glaucoma Study Group (2001) Natural history of normal-tension glaucoma. Ophthalmology 108(2): 247–53.

12.Leske MC, Heijl A, Hussein M, et al.; Early Manifest Glaucoma Trial Group (2003) Factors for glaucoma progression and the effect of treatment: The early manifest glaucoma trial. Arch Ophthalmol 121(1):48–56.

Core Messages

››Adherence to eye drops and persistence of medi­ cation is a significant problem among the glaucoma population.

››Physicians cannot accurately identify patients who are nonadherent.

››An open and nonjudgmental discussion with patients is critical.

››Overcomingobstacleslikenonadherencerequires education, reassurance, and support from the eye care team.

30.1  What Issues Are at Work

in Patient Noncompliance?

Glaucoma is recognized as a significant cause of blindness worldwide. It is a disease that affects over 2 million people in the United States today, a number that is projected to increase to more than 3 million by the year 2020. The mainstay of therapy for open-angle glaucoma is maintaining low intraocular pressure to prevent or retard progression of the disease. However, despite the possibility of devastating vision loss, low adherence to and persistence on medical treatment remains surprisingly poor. Unfortunately, glaucoma is one of the many chronic diseases in which poor adherence

A. L. Jamil ( )

Glaucoma Consultants Northwest, Arnold Medical Pavilion, 1221 Madison Street, Suite 1124, Seattle, WA 98104, USA e-mail: annisa_j@hotmail.com

leads to disease progression, which in turn leads to increased health costs. In fact, hospital admission data in the United States show that 33–69% of all admissions are the result of noncompliance with medications, costing the system approximately $100 billion a year [1, 9, 10, 16]. Understanding the motivating or demotivating factors behind these behaviors is essential to provide quality care to our patients. The two key concepts involved are those of adherence and persistence.

30.1.1  What Is Adherence?

Adherence is defined as the regular use and correct administration of medication as prescribed by healthcare professionals. This is preferred over the term “compliance” which has the disadvantage of conveying a passive role for the patients, a role in which the patients follow orders. Adherence denotes an active participatory role based on a common therapeutic goal for both the practitioner and patient. Interestingly, adherence is usually highest in 5 days preceding the appointment, a phenomenon known as “white-coat adherence” [12]. Obviously, this phenomenon can confound treatment objectives and account for progression at seemingly controlled pressures.

30.1.2  What Is Persistence?

Persistence describes the period of time when there is consistent use of the prescribed medical regimen. With regard to persistence with glaucoma medications, clinical studies demonstrate that most patients discontinue