Glaucoma: A review of current management, patients’ adherence, direct and indirect cost, and barriers to drug delivery

Abstract

Glaucoma is the world’s leading cause of permanent blindness, influenced by numerous variables, including socio-demographic factors. This review considered existing management practices and innovative methods of drug delivery, as well as how they relate to patient adherence and therapy costs. Literatures were compiled using search engines including ScienceDirect, PubMed, Google Scholar and WHO database. The eye is a complex organ with various anatomical barriers presenting significant challenges in treating glaucoma due to poor patient compliance with topical ocular medications. Advanced drug delivery systems like implants, nano or microparticles, punctal plugs, contact lenses, topical ring-type systems, gels, and other depot systems such as intracameral, supraciliary, and intravitreal applied in the extraocular, periocular, or intraocular sites, significantly enhance medication absorption, reduce adverse effects, and improve patient compliance. Poor treatment adherence, stemming from various reasons, lead to inadequate glaucoma management, increasing direct (34 to 45 %) and indirect costs (55 to 66 %) of therapy. As a result, a variety of treatments including enhanced drug delivery systems have been tested to address these concerns, and some modern pharmaceuticals and drug delivery technologies are being developed.