Purpose: To systematically identify and describe common obstacles to medication adherence (i.e., compliance) for patients with glaucoma.
Methods: A prospective case series of structured interviews were conducted with 48 patients with glaucoma. The subjects' responses were recorded verbatim on interview forms as well as recorded on audiotapes. Situational obstacles to medication adherence were elicited. Using hierarchical cluster analysis, the situational descriptions were stratified, grouped, and analyzed by frequency distribution.
Results: Seventy-one unique situational obstacles were reported. These were then grouped into 4 defined and separate categories: situational/environmental factors (35 of 71 situations; 49%), medication regimen (23 of 71; 32%), patient factors (11 of 71; 16%), and provider factors (2 of 71; 3%).
Conclusion: Significant barriers to compliance exist for patients with glaucoma in addition to those cited by previous ophthalmic studies. A systematic classification (i.e., taxonomy) of these barriers was formulated to assist in optimizing patient education and problem-solving regarding prescribed therapeutic regimens.
Glaucoma is one of the leading causes of blindness in the United States and worldwide. 1 It is estimated that over 2.5 million Americans have glaucoma and that more than 130,000 of them are blind from the disease. 2 Primary open-angle glaucoma is the most common form of glaucoma. Medical management of open-angle glaucoma, while not curative, can prevent or minimize the impact of the disease. 3 Initial therapy entails topical administration of 1 or more glaucoma medications to lower the intraocular pressure (IOP). 4 Given the asymptomatic nature of glaucoma and the effort required for treatment, patients are at risk for non-adherence and compliance problems with the therapeutic regimen.
Taxonomies (i.e., systematic classifications) exist that describe everyday situations, health beliefs, and social and environmental factors that create obstacles for adherence (i.e., compliance) to dietary management in both adolescent and adult patients with diabetes mellitus. 5,6 Such taxonomies can guide development of individual treatment algorithms for dietary adherence. Ophthalmology might similarly benefit from a systematic classification of barriers to compliance for patients with glaucoma.
To our knowledge, no studies to date have employed a systematic approach to identify these barriers to compliance in glaucoma management. Moreover, there currently exists no accepted standard to assess a patient's level of compliance to glaucoma therapy. This study seeks to identify, describe, and classify everyday obstacles to compliance (i.e., develop a taxonomy) for patients with glaucoma.