Simplification of eye drop regimes helps reduce involuntary non-compliance with glaucoma treatment

Abstract

Dear Editor, We read with interest the article by Buller and co-workers [1] indicating that patients anticipate and experience less inconvenience from once daily (OD) eye drop regimes compared to more complicated alternatives. They suggest, therefore, that OD regimes will encourage voluntary compliance. We would propose that OD treatment regimes also reduce involuntary non-compliance and are particularly advantageous for elderly patients. We surveyed 70 consecutive glaucoma patients by means of interview administered questionnaire to determine whether the medication they were actually using was the same as that advised by the ophthalmologist at their previous clinic visit. It was found that 11/70 (16%) were not compliant with the regime recommended. Six of these 11 were using the drops at an inappropriate frequency, which was felt to be due to a failure to make the treatment regime clear during the previous consultation. The other five of the 11 non-compliant patients were using medication other than that intended. Although the initial prescription for glaucoma medication may be given by an ophthalmologist, the responsibility for ongoing prescription of treatment in many health care systems rests with the family doctor or general practitioner. The source of error in these cases, therefore, was the system of communication between specialist and general practitioner. Non-compliant patients (mean age 78.9) were significantly older than those who complied (mean age 69.9) (p=0.04). Patients using OD drop treatments were also significantly more likely to be compliant than those on more complex regimes; only 1 of 33 OD patients failed to comply, compared to 10 of 37 patients prescribed more frequent drop administration (p<0.01). The mean number of drops instilled per day was, therefore, significantly higher in the group of patients who were non-compliant compared to those who complied, being 2.8 drops per day versus 1.9 drops per day (p=0.02). Two sources of involuntary non-compliance were, therefore, identified: patients who did not understand what treatment regime to follow and family doctors who were not providing continued supply of the glaucoma medication intended by the ophthalmologist. Our survey suggests that both effects might be reduced by opting for simplified treatment regimes and making sure that the regime is understood by the patient and their family doctor. These steps are of particular importance for elderly patients who are more likely to be on numerous systemic and topical medications for other conditions and who may be more easily confused with the administration of these treatments. Where using OD therapy is no longer adequate to control intra-ocular pressure, we would encourage a reGraefe’s Arch Clin Exp Ophthalmol (2007) 245:327–328 DOI 10.1007/s00417-006-0438-8