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A Novel Approach to Helping People with Glaucoma Use Their Drops Routinely

McDonald, John E., OD, MS1,2*; Dickinson, Jane K., RN, PhD2

Optometry and Vision Science: May 2019 - Volume 96 - Issue 5 - p 331–334
doi: 10.1097/OPX.0000000000001366

ABSTRACT Pharmacy data reveal that 70% of patients were missing one or more days worth of drops out of five. Adopting approaches to behavior change and management skills used for people with diabetes may provide insight to improve self-management of glaucoma. Every person who is diagnosed with a chronic health condition such as glaucoma has unique life circumstances that may present barriers to behavior change. An accurate diagnosis and a treatment plan are useless if patients do not use their prescribed eye drops. Active listening and effective communication can result in persons who are more engaged in their self-care behaviors. Collaborative communication using person-centered and strengths-based messages could help eye care providers identify challenges and concerns for people with glaucoma who are experiencing inconsistencies with their eye drops. In an atmosphere where patients can discuss their challenges with treatment recommendations without judgment or fear, they are more likely to trust their provider and therefore share their situation openly and honestly. This is accomplished by choosing language that communicates mutually-agreed-upon self-management goals and addresses and strengthens individual and clinical outcomes. The eye care professional is then seen by the patient as a resource who can empathize when setbacks occur and reinforce the patient's self-management goals. Open-ended questions and tell-ask-tell approaches for identifying barriers to care are keys to more effective communication and trusting relationships. This includes recognizing that glaucoma is associated with increased rates of anxiety or depression that may be an overlooked barrier to self-management. By adopting language recommendations from diabetes care and education, eye care practitioners may be better equipped to help people with glaucoma improve their self-care.

1Private Practice, Chico, California

2Diabetes Education and Management, Teachers College Columbia University, New York, New York *

Supplemental Digital Content: The Appendix, the screening tools that may be used in a clinical setting to evaluate vision impairment, depression and glaucoma quality of life when barriers to patient self-management are encountered, is available at

Submitted: April 2, 2018

Accepted: January 20, 2019

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions: Writing – Original Draft: JEM; Writing – Review & Editing: JKD.

Supplemental Digital Content: Direct URL links are provided within the text.

© 2019 American Academy of Optometry