Complexities of Medical Glaucoma Therapy--the Elderly Patient in Focus

Abstract

In order to treat glaucoma with medication successfully, the patient needs to participate actively in the process. "Adherence", formerly "compliance", describes the willingness and capacity to follow the prescribed regimen every day. It is not trivial to measure adherence and persistence, as this quite often relies on self reports by the patient or speculations by the physician. Hence, the overall reported adherence may vary from 5 to 95 %. In general, the following categories have been defined for reduced adherence: medication-related factors, patient-related factors, environmental factors and social factors. Age has been found to intensify or modify many of these factors. Older adults often face various challenges, due to motor disabilities, reduced visual acuity or impaired cognitive capabilities. In patients with movement disorders or tactile limitations, the target area can be reached more successfully with standard eye drop bottles than with single-use dose units. This should be considered if antiglaucoma eye drops are prescribed in the elderly. Frequency of application is a main factor influencing adherence. Monotherapy--as provided with prostaglandins--or drops with a fixed combination have proven to support adherence significantly. A significant boost for self-monitoring activities is initiated by the growing market of electronic devices, like smartphones. For instance, they can provide acoustic alarms as reminders to apply the eye drops. It is evident that any external support or disease-related information by family members, the medical practitioners, support groups or even electronic devices may improve adherence and persistence, even in patients with severe impairments.